Yu Qing, Liu Yang, Sun Mang, Zhang Jing, Zhao Yan, Liu Fengzhi, Li Shangyingying, Tu Shengfen
Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.
Paediatr Anaesth. 2017 Nov;27(11):1108-1114. doi: 10.1111/pan.13235. Epub 2017 Sep 20.
Intranasal dexmedetomidine can provide adequate sedation during short procedures. However, previous literature investigating the single-dose use of intranasal dexmedetomidine for sedation during transthoracic echocardiography in younger children is scarce, and the effects of age on sedation with intranasal dexmedetomidine remain controversial.
This study was to determine the 50% effective dose and estimate the 95% effective dose of single-dose intranasal dexmedetomidine to induce sedation in pediatric patients with noncyanotic congenital heart disease, and also determine the effect of age on the dose required for sedation.
Patients were stratified into three age groups of 1-6 months, 7-12 months, and 13-36 months. Intranasal dexmedetomidine started at a dose of 2 μg kg on the first patient. The dose of dexmedetomidine for each subsequent patient was determined by the previous patient's response using Dixon's up-and-down method with an interval of 0.25 μg kg . Sedation scale and recovery were assessed by the Modified Observer Assessment of Alertness and Sedation Scale and Modified Aldrete Recovery Score. The 50% effective dose was determined by Dixon's up-and-down method. In addition, both 50% effective dose and 95% effective dose were obtained using a probit regression approach. Other variables included sedation onset time, echocardiography time, wake-up time, discharge time, heart rate, blood pressure, oxygen saturation, respiratory rate, and adverse events such as vomiting, regurgitation, and apnea.
The study population was comprised of 70 patients. The 50% effective dose (95% confidence interval) and the 95% effective dose (95% confidence interval) of intranasal dexmedetomidine for sedation were 1.8 (1.58-2.00) μg kg and 2.2 (1.92-5.62) μg kg in patients aged 1-6 months, 1.8 (1.61-1.95) μg kg and 2.1 (1.90-2.85) μg kg in patients aged 7-12 months, 2.2 (1.92-2.37) μg kg and 2.7 (2.34-6.88) μg kg in patients aged 13-36 months, respectively. The 50% effective dose in age group 13-36 months was higher than those of age group 1-6 months (P = .042) and 7-12 months (P = .043). There were no differences in sedation onset time, echocardiography time, wake-up time, and discharge time between groups. None of the patients experienced oxyhemoglobin desaturation, hypotension, or bradycardia during the procedure. No significant adverse events occurred.
Single-dose of intranasal dexmedetomidine was an effective agent for patients under the age of 3 years requiring sedation for transthoracic echocardiography. The 50% effective dose of intranasal dexmedetomidine for transthoracic echocardiography sedation in children aged 13-36 months was higher than in children <13 months.
鼻内给予右美托咪定可在短时间手术中提供充分的镇静效果。然而，以往关于鼻内给予右美托咪定单剂量用于年幼儿童经胸超声心动图检查镇静的文献较少，且年龄对鼻内给予右美托咪定镇静效果的影响仍存在争议。
本研究旨在确定单剂量鼻内给予右美托咪定诱导非紫绀型先天性心脏病患儿镇静的50%有效剂量并估算95%有效剂量，同时确定年龄对镇静所需剂量的影响。
将患者分为1至6个月、7至12个月和13至36个月三个年龄组。第一名患者鼻内给予右美托咪定的起始剂量为2μg/kg。后续每位患者右美托咪定的剂量根据前一位患者的反应采用Dixon上下法确定，间隔为0.25μg/kg。通过改良警觉与镇静观察评分量表和改良Aldrete恢复评分评估镇静程度和恢复情况。采用Dixon上下法确定50%有效剂量。此外，使用概率回归方法获得50%有效剂量和95%有效剂量。其他变量包括镇静起效时间、超声心动图检查时间、苏醒时间、出院时间、心率、血压、血氧饱和度、呼吸频率以及呕吐、反流和呼吸暂停等不良事件。
研究人群包括70名患者。1至6个月龄患者鼻内给予右美托咪定镇静的50%有效剂量（95%置信区间）和95%有效剂量（95%置信区间）分别为1.8（1.58 - 2.00）μg/kg和2.2（1.92 - 5.62）μg/kg；7至12个月龄患者分别为1.8（1.61 - 1.95）μg/kg和2.1（1.90 - 2.85）μg/kg；13至36个月龄患者分别为2.2（1.92 - 2.37）μg/kg和2.7（2.34 - 6.88）μg/kg。13至36个月龄组的50%有效剂量高于1至6个月龄组（P = 0.042）和7至12个月龄组（P = 0.043）。各组间镇静起效时间、超声心动图检查时间、苏醒时间和出院时间无差异。术中无患者出现氧合血红蛋白饱和度降低、低血压或心动过缓。未发生明显不良事件。
单剂量鼻内给予右美托咪定对3岁以下需要经胸超声心动图检查镇静的患者是一种有效的药物。13至36个月龄儿童经胸超声心动图检查镇静时鼻内给予右美托咪定的50%有效剂量高于13个月以下儿童。
