Xu Jin, Deng Xiao-Ming, Wei Ling-Xin, Yang Dong, Liu Ju-Hui, Zhi Juan, Li Ya-Nan
Department of Anesthesiology, Plastic Surgery Hospital, CAMS and PUMC, Beijing 100144,China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2016 Dec 20;38(6):627-631. doi: 10.3881/j.issn.1000-503X.2016.06.001.
Objective To observe the effects of two different intranasal dexmedetomidine doses as premedication on the EC of sevoflurane for successful laryngeal mask airway placement in children. Methods Children aged 3-6 years, of American Society of Anesthesiologists physical status 1, and scheduled for plastic surgery were enrolled in this study. Children were assigned to receive either spray administration of intranasal dexmedetomidine 1 μg/kg (group D1, n=21) or 2 μg/kg (group D2, n=20) approximately 30 minutes before anesthesia. Anesthesia was induced with sevoflurane up to 8% in 100% O, with fresh gas flow set to 6 L/min. After the pupil fixed to the middle position, sevoflurane dial setting was reduced to 5% and fresh gas flow reduced to 3 L/min. The endtidal sevofluran (ET) concentration for laryngeal mask airway insertion sustained for 10 minutes after vein intubation, which was determined according to the Dixon's up and down method. The initial endtidal sevoflurane concentration in each group was set at 2%. ET was increased/decreased (1:1.2) in the next patient according to the response to laryngeal mask airway insertion. Bispectral index, mask acceptance, all response to laryngeal mask airway insertion, and ET of laryngeal mask airway insertion of children were recorded. Results The bispectral index value was 77.4±3.6 in group D2, which was significantly lower than that (87.4±1.9) in group D1 when children entered operation room (P<0.05). Mask acceptance was 76.2% in group D1 and 90.0% in group D2. The EC of sevoflurane for laryngeal mask airway insertion was 1.09% (95% CI=0.89%-1.28%) in group D2, which was lower than 1.59% (95% CI=1.41%-1.78%) in group D1 (P<0.05). Conclusion Compared with the dose of 1 μg/kg, spray administration of intranasal dexmedetomidine 2 μg/kg as premedication can reduce the sevoflurane EC for successful laryngeal mask airway placement in children.
目的 观察两种不同剂量鼻内给予右美托咪定作为术前用药对儿童七氟醚喉罩置入有效浓度（EC）的影响。方法 本研究纳入年龄3至6岁、美国麻醉医师协会身体状况分级为1级且计划行整形手术的儿童。在麻醉前约30分钟，将儿童分为两组，分别接受鼻内喷雾给予1 μg/kg右美托咪定（D1组，n = 21）或2 μg/kg右美托咪定（D2组，n = 20）。用七氟醚在100%氧气中诱导麻醉，初始浓度达8%，新鲜气流设置为6 L/min。瞳孔固定至中间位置后，将七氟醚刻度盘设置降至5%，新鲜气流降至3 L/min。根据 Dixon 上下法确定静脉插管后维持10分钟喉罩置入时的呼气末七氟醚（ET）浓度。每组初始呼气末七氟醚浓度设定为2%。根据下一位患者喉罩置入的反应，将ET浓度增加/降低（1:1.2）。记录儿童的脑电双频指数、面罩接受情况、所有喉罩置入反应及喉罩置入时的ET浓度。结果 进入手术室时，D2组脑电双频指数值为77.4±3.6，显著低于D1组的87.4±1.9（P<0.05）。D1组面罩接受率为76.2%，D2组为90.0%。D2组喉罩置入时七氟醚的EC为1.09%（95%CI = 0.89% - 1.28%），低于D1组的1.59%（95%CI = 1.41% - 1.78%）（P<0.05）。结论 与1 μg/kg剂量相比，术前鼻内喷雾给予2 μg/kg右美托咪定可降低儿童成功置入喉罩时七氟醚的EC。
