Zhang Hongquan, Fang Baojun, Zhou Wenjing
Department of Anesthesiology, Liaocheng People's Hospital Department of Anesthesiology Department of General ward, women and children health of Dongchangfu District, Liaocheng, Shandong, China.
Medicine (Baltimore). 2017 Jan;96(1):e5815. doi: 10.1097/MD.0000000000005815.
Flexible bronchoscopy has been more and more used for diagnosis and management diseases of respiratory system in pediatrics. Previous studies have reported that remifentanil (RF) and propofol are safe and effective for flexible bronchoscopy in adults, however, there have no trials evaluate the efficacy of DEX-RF versus dexmedetomidine-propofol in children undergoing flexible bronchoscopy.We divided 123 children undergoing flexible bronchoscopy with DEX-RF or dexmedetomidine-propofol into 2 groups: Group DR (n = 63, DEX infusion at 1.0 μg kg for 10 minutes, then adjusted to 0.5-0.7 μg kg h; RF infusion at 1.0 μg kg for 5 minutes, then adjusted to 0.05-0.2 μg kg min), Group DP (n = 60, DEX infusion at 1.0 μg kg for 10 minutes, then adjusted to 0.5-0.7 μg kg h; propofol infusion at 10 μg kg for 5 minutes, then adjusted to 0.05-0.1 μg kg min). Ramsay sedation scale of the 2 groups was maintained at 3. Anesthesia onset time; total number of intraoperative patient movements; hemodynamics; total cumulative dose of DEX; amount of and time to first-dose rescue midazolam and lidocaine; postoperative recovery time; adverse events; and bronchoscopist satisfaction score were recorded.Anesthesia onset time was significantly shorter in DP (8.22 ± 2.48 vs 12.25 ± 6.43 minutes, respectively, for DP, DR, P = 0.015). The perioperative hemodynamic profile was more stable in DR than DP group. More children moved during flexible bronchoscopy in DP group (P = 0.009). Total dose of rescue midazolam and lidocaine was significantly higher in DR than in DP (P < 0.001). Similarly, the time to first dose of rescue midazolam and lidocaine was significantly longer in DP than in DR (P < 0.001). Total cumulative dose of DEX was more in DR than DP group (P < 0.001). The time to recovery for discharge from the postanesthesia care unit (PACU) was significantly shorter in DP than in DR group (P < 0.001). The bronchoscopist-satisfaction scores were higher for DR than DP (P = 0.036). There were significant differences between the 2 groups in terms of the overall incidence of hypertension, tachycardia, and hypoxemia (P < 0.05).Although underwent longer recovery time and more incidence of rescue scheme, DEX-RF resulted in more stable hemodynamic profiles and bronchoscopist-satisfaction scores, lesser patient movements, and can hence be more effectively used in children undergoing flexible bronchoscopy than dexmedetomidine-propofol.
可弯曲支气管镜检查在儿科呼吸系统疾病的诊断和治疗中应用越来越广泛。既往研究报道，瑞芬太尼（RF）和丙泊酚在成人可弯曲支气管镜检查中安全有效，然而，尚无试验评估右美托咪定-瑞芬太尼与右美托咪定-丙泊酚在儿童可弯曲支气管镜检查中的疗效。我们将123例接受可弯曲支气管镜检查的儿童分为两组：DR组（n = 63，静脉输注右美托咪定1.0μg/kg，持续10分钟，然后调整至0.5 - 0.7μg·kg/h；静脉输注瑞芬太尼1.0μg/kg，持续5分钟，然后调整至0.05 - 0.2μg·kg/min），DP组（n = 60，静脉输注右美托咪定1.0μg/kg，持续10分钟，然后调整至0.5 - 0.7μg·kg/h；静脉输注丙泊酚10μg/kg，持续5分钟，然后调整至0.05 - 0.1μg·kg/min）。两组的Ramsay镇静评分均维持在3分。记录麻醉起效时间、术中患者总活动次数、血流动力学指标、右美托咪定的总累积剂量、首次使用抢救用咪达唑仑和利多卡因的剂量及时间、术后恢复时间、不良事件以及支气管镜检查医生的满意度评分。DP组的麻醉起效时间明显短于DR组（DP组和DR组分别为8.22±2.48分钟和12.25±6.43分钟，P = 0.015）。DR组围手术期血流动力学指标比DP组更稳定。DP组在可弯曲支气管镜检查过程中有更多儿童出现活动（P = 0.009）。DR组抢救用咪达唑仑和利多卡因的总剂量明显高于DP组（P < 0.001）。同样，DP组首次使用抢救用咪达唑仑和利多卡因的时间明显长于DR组（P < 0.001）。DR组右美托咪定的总累积剂量多于DP组（P < 0.001）。DP组从麻醉后恢复室（PACU）出院的恢复时间明显短于DR组（P < 0.001）。DR组支气管镜检查医生的满意度评分高于DP组（P = 0.036）。两组在高血压、心动过速和低氧血症的总体发生率方面存在显著差异（P < 0.05）。尽管右美托咪定-瑞芬太尼组恢复时间较长且抢救方案的发生率较高，但与右美托咪定-丙泊酚相比，其血流动力学指标更稳定，支气管镜检查医生的满意度评分更高，患者活动更少，因此在接受可弯曲支气管镜检查的儿童中可能比右美托咪定-丙泊酚更有效。
