Choi Eun Kyung, Seo Yijun, Lim Dong Gun, Park Sungsik
Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Daegu, Korea.
Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
Korean J Anesthesiol. 2017 Jun;70(3):299-304. doi: 10.4097/kjae.2017.70.3.299. Epub 2017 Mar 15.
Postoperative nausea and vomiting (PONV) is the major complication related to general anesthesia, occurring in 60-80% of patients after thyroidectomy. The objective of this study was to compare the effects of an intraoperative dexmedetomidine infusion with remifentanil, as anesthetic adjuvants of balanced anesthesia, on PONV in patients undergoing thyroidectomy.
Eighty patients scheduled for thyroidectomy were randomized into the following two groups: 1) The dexmedetomidine group (Group D), who received an initial loading dose of dexmedetomidine (1 µg/kg over 10 min) during the induction of anesthesia, followed by a continuous infusion at a rate of 0.3-0.5 µg/kg/h; 2) the remifentanil group (group R), who received remifentanil at an initial target effect site concentration of 4 ng/ml during the induction of anesthesia, followed by a target effect site concentration of 2-3 ng/ml. PONV was assessed during the first 24 hours in 2 time periods (0-2 h and 2-24 h). The pain intensity, sedation score, extubation time, and hemodynamics were also assessed.
During the 2 time periods, the incidence and severity of PONV in group D were significantly lower than in group R. In addition, the need for rescue antiemetics was significantly lower in group D than in group R. The effect of dexmedetomidine on postoperative pain relief (2-24 h) was superior to that of remifentanil. The hemodynamics were similar in both groups, whereas eye opening and extubation time were delayed in group D.
Adjuvant use of intraoperative dexmedetomidine infusion may be effective for the prevention of PONV.
术后恶心呕吐（PONV）是全身麻醉相关的主要并发症，在甲状腺切除术后60 - 80%的患者中发生。本研究的目的是比较术中输注右美托咪定与瑞芬太尼作为平衡麻醉辅助药物对甲状腺切除患者PONV的影响。
80例计划行甲状腺切除术的患者随机分为以下两组：1）右美托咪定组（D组），在麻醉诱导期间接受初始负荷剂量的右美托咪定（10分钟内1μg/kg），随后以0.3 - 0.5μg/kg/h的速率持续输注；2）瑞芬太尼组（R组），在麻醉诱导期间接受初始效应室浓度为4ng/ml的瑞芬太尼，随后效应室浓度为2 - 3ng/ml。在最初24小时内分两个时间段（0 - 2小时和2 - 24小时）评估PONV。还评估了疼痛强度、镇静评分、拔管时间和血流动力学。
在两个时间段内，D组PONV的发生率和严重程度均显著低于R组。此外，D组抢救性使用止吐药的需求显著低于R组。右美托咪定对术后疼痛缓解（2 - 24小时）的效果优于瑞芬太尼。两组血流动力学相似，而D组睁眼和拔管时间延迟。
术中输注右美托咪定作为辅助用药可能对预防PONV有效。
