Abdel Hamid Mona Hossam Eldin
Department of Anesthesia, ICU and Pain Management, Cairo University, Cairo, Egypt.
Anesth Essays Res. 2017 Oct-Dec;11(4):1070-1074. doi: 10.4103/aer.AER_148_17.
Anesthesia for arthroscopic shoulder surgery is challenging due to the need for oligaemic surgical field as well as a good postoperative recovery profile.
The present study was prospective, randomized to evaluate the efficacy of dexmdetomidine infusion compared to that of fentanyl in patients undergoing arthroscopic shoulder surgery under general anesthesia.
A total of 60 patients aged from thirty to fifty years, American Society of Anesthesiologists Class I/II of either sex for arthroscopic shoulder surgery, were included. The patients were divided into two groups of 30 patients each. Group I received dexmedetomidine loading 1 μg/kg over 10 min followed by maintenance 0.5 μg/kg/h and Group II Fentanyl loading 1 μg/kg followed by maintenance 0.5 μg/kg/h.
Hemodynamic readings (Heart rate HR, and mean arterial blood pressure MAP) were recorded after the start of the study drug infusion (T1), after intubation (T2), then every 15 minutes till the end of surgery (T15, T30, T45, T60, T75, T90). In the PACU, MAP, and HR were recorded on arrival, after 30 min, 1 hr, and 2 hrs (R0, R30, R1 hr, R2 hr) Postoperative analgesia was assessed by visual analogue scale (VAS), Modified Observers's Assessment of Alertness and Sedation OAA/S was recorded on arrival to PACU.
This study showed that in the dexmedatomidine group there was statistically significant decrease of MAP and HR after drug infusion up to two hours in the recovery period, more sedation, better control of pain and surgeon satisfaction.
Iv infusion of dexamedatomidine may be an attractive option during arthroscopic shoulder surgery as it provided a better hypotensive anesthesia by lowering MAP and HR which leads to better surgical field and surgeon satisfaction than iv infusion fentanyl along with a better postoperative VAS.
由于需要减少手术视野出血以及良好的术后恢复情况，肩关节镜手术的麻醉具有挑战性。
本研究为前瞻性随机研究，旨在评估在全身麻醉下行肩关节镜手术的患者中，右美托咪定输注与芬太尼相比的疗效。
纳入60例年龄在30至50岁之间、美国麻醉医师协会分级为I/II级的男女患者，进行肩关节镜手术。患者被分为两组，每组30例。第一组在10分钟内静脉输注负荷剂量右美托咪定1μg/kg，随后以0.5μg/kg/h维持；第二组静脉输注负荷剂量芬太尼1μg/kg，随后以0.5μg/kg/h维持。
在研究药物输注开始后（T1）、插管后（T2）记录血流动力学指标（心率HR和平均动脉压MAP），然后每15分钟记录一次，直至手术结束（T15、T30、T45、T60、T75、T90）。在麻醉后恢复室（PACU），到达时、30分钟后、1小时后和2小时后记录MAP和HR（R0、R30、R1小时、R2小时）。通过视觉模拟评分法（VAS）评估术后镇痛情况，到达PACU时记录改良的观察者警觉和镇静评分（OAA/S）。
本研究表明，右美托咪定组在恢复期药物输注后长达两小时内，MAP和HR有统计学意义的下降，镇静作用更强，疼痛控制更好，外科医生满意度更高。
静脉输注右美托咪定可能是肩关节镜手术期间一种有吸引力的选择，因为它通过降低MAP和HR提供了更好的低血压麻醉，与静脉输注芬太尼相比，能带来更好的手术视野和外科医生满意度，以及更好的术后VAS评分。
