镇静对皮质激活的影响：一项比较咪达唑仑、丙泊酚和右美托咪定镇静对听觉处理影响的随机研究。
The Effect of Sedation on Cortical Activation: A Randomized Study Comparing the Effects of Sedation With Midazolam, Propofol, and Dexmedetomidine on Auditory Processing.
作者信息
Frölich Michael A, Banks Catiffaney, Ness Timothy J
机构信息
From the *Department of Anesthesiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama; and †Emory Health Care System, Atlanta, Georgia.
出版信息
Anesth Analg. 2017 May;124(5):1603-1610. doi: 10.1213/ANE.0000000000002021.
BACKGROUND
Every day, millions of people undergo surgical procedures facilitated by anesthesia. Yet, there is no clinically accepted measure to predict the effects of sedation or anesthesia on the central nervous system. Auditory brain activation may provide an objective and quantifiable method to measure of the effects of sedation on neuronal processing.
METHODS
This is a randomized clinical trial. Forty-eight healthy volunteers were randomly assigned to receive 1 of 3 sedative drugs (midazolam [n = 11], propofol [n = 12], or dexmedetomidine [n = 12]) at a concentration adjusted to achieve mild sedation by self-rating, or to a no-drug control group (n = 13). Participants underwent functional magnetic resonance imaging while listening to music in a 5-minute block design experiment. We tested the hypothesis that mild sedation changes the magnitude or extent of cortical activation of an auditory stimulus.
RESULTS
We observed a significant reduction in auditory activation in both the dexmedetomidine (P = .001) and midazolam (P = .029) but not the propofol group (P = .619) when compared with saline control.
CONCLUSIONS
Our findings indicate that, compared with saline control, there is a significant reduction of brain activation in the auditory cortex in response to midazolam and dexmedetomidine but not propofol when given at mildly sedative doses. This method serves as a novel approach to quantify the effects of sedative agents in an objective fashion.
背景
每天，数以百万计的人在麻醉的辅助下接受外科手术。然而，目前尚无临床上被广泛接受的方法来预测镇静或麻醉对中枢神经系统的影响。听觉脑激活可能提供一种客观且可量化的方法来衡量镇静对神经元处理的影响。
方法
这是一项随机临床试验。48名健康志愿者被随机分配接受三种镇静药物中的一种（咪达唑仑[n = 11]、丙泊酚[n = 12]或右美托咪定[n = 12]），药物浓度根据自我评分调整以达到轻度镇静，或分配至无药物对照组（n = 13）。参与者在一个5分钟的分组设计实验中听音乐时接受功能磁共振成像检查。我们检验了轻度镇静会改变听觉刺激的皮质激活程度或范围这一假设。
结果
与生理盐水对照组相比，我们观察到右美托咪定组（P = 0.001）和咪达唑仑组（P = 0.029）的听觉激活显著降低，但丙泊酚组未出现显著降低（P = 0.619）。
结论
我们的研究结果表明，与生理盐水对照组相比，给予轻度镇静剂量的咪达唑仑和右美托咪定后，听觉皮质的脑激活显著降低，但丙泊酚未出现这种情况。这种方法为客观量化镇静剂的作用提供了一种新途径。
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