Xie Zhubin, Shen Weihua, Lin Jingyi, Xiao Liwen, Liao Minyan, Gan Xiaoliang
Department of Anesthesiology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China.
Department of Anesthesiology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China.
Am J Emerg Med. 2017 Aug;35(8):1126-1130. doi: 10.1016/j.ajem.2017.03.021. Epub 2017 Mar 18.
Mucosal atomization device (MAD) was designed to increase the bioavailability of intranasal medications by facilitating absorption, the present study aimed to evaluate and compare the sedation effects of intranasal dexmedetomidine delivered as drops versus sprays on pediatric responses to intravenous cannulation.
One hundred and six pediatric patients (aged from 2 to 5years) scheduled for elective ophthalmic surgery were intranasally received a dose of 2μg/kg in 20μl/kg of dexmedetomidine for sedation to reduce response to venous cannulation. The patients were randomized into syringe group and MAD group in which dexmedetomidine was delivered as drops or sprays via syringe or MAD respectively. The primary outcome was the response to peripheral vein cannulation assessed by the FLACC scores (faces, legs, activity, cry and consolability) 30min after intranasal administration of dexmedetomidine. The secondary outcomes included acceptance for intranasal medication, sedation onset time, and needle insertion times and any adverse event at the preoperative holding area.
The FLACC scores in MAD group were significantly decreased than that treated by drops (P=0.021). The acceptance for intranasal administration between both groups was comparable (P>0.05), the onset time and the incidences in two and more times of needle insertion did not differ significantly between syringe and MAD groups (all P>0.05). None of patients were required to clinically intervene in heart rates reduction and none suffered respiratory depression after administrations of dexmedetomidine in either group.
Intranasal dexmedetomidine by sprays offers better sedation effects to reduce responses to venous cannulation than drops.
黏膜雾化装置（MAD）旨在通过促进吸收来提高鼻内给药的生物利用度，本研究旨在评估和比较滴鼻与喷雾两种方式给予小儿静脉置管时鼻内右美托咪定的镇静效果。
106例计划行择期眼科手术的2至5岁小儿患者，鼻内给予2μg/kg（溶于20μl/kg）右美托咪定用于镇静，以减轻对静脉置管的反应。患者被随机分为注射器组和MAD组，分别通过注射器或MAD以滴鼻或喷雾方式给予右美托咪定。主要结局是在鼻内给予右美托咪定30分钟后，通过面部表情、腿部动作、活动情况、哭声及安慰度（FLACC）评分评估对外周静脉置管的反应。次要结局包括对鼻内给药的接受度、镇静起效时间、进针次数以及术前等待区的任何不良事件。
MAD组的FLACC评分显著低于滴鼻组（P = 0.021）。两组间对鼻内给药的接受度相当（P>0.05），注射器组和MAD组的起效时间以及进针两次及以上的发生率差异均无统计学意义（均P>0.05）。两组在给予右美托咪定后，均无患者因心率降低需要临床干预，也无患者出现呼吸抑制。
喷雾方式给予鼻内右美托咪定比滴鼻在减轻静脉置管反应方面具有更好的镇静效果。
