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[右美托咪定对日间手术手术室接受牙病治疗的儿童全身麻醉后苏醒期躁动的影响]

[Effect of dexmedetomidine on emergence agitation after general anesthesia in children undergoing odontotherapy in day-surgery operating room].

作者信息

Lin Luo, Yueming Zhang, Meisheng Li, Jiexue Wang, Yang Ji

机构信息

State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Anesthesiology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.

State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.

出版信息

Hua Xi Kou Qiang Yi Xue Za Zhi. 2017 Dec 1;35(6):613-617. doi: 10.7518/hxkq.2017.06.010.

Abstract

OBJECTIVE

To study the effectiveness of dexmedetomidine used for general anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room in reducing the incidence of emergence agitation (EA).

METHODS

Eighty children undergoing odontotherapy and under general anesthesia in day-surgery operating room were randomized into two groups, group A (n=40) and group B (n=40). Each patient in group A was administered with a bolus dose of dexmedetomidine (1.0 μg·kg⁻¹, saline diluted to 10 mL) pump-infused after intubation and a maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Each patient in group B was administered with a bolus dose of normal saline 10 mL pump-infused after intubation and maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Gender, age, weight, physical status according to the American Society of Anesthesiologists, perioperative heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO₂), sufentanil dosage, duration of surgery, time of extubation, time of regaining consciousness, and time to reach modified Aldrete's score≥12 were recorded. Behavior in postanesthesia care unit was rated on the four-point agitation scale.

RESULTS

Compared with group B, decreases were observed in HR and MAP at the beginning of operation, in 10 and 30 min, 1 and 2 h after the beginning of operation, and after extubation of group A (P<0.05). Sufentanil dosage and incidence of EA during recovery of group A were also lower than those of group B (P<0.05). Time to regain consciousness and time to reach modified Aldrete's score≥12 of group A were longer than those of group B (P<0.05). No statistical difference was observed between other indexes of the two groups.

CONCLUSIONS

As an anesthetic used for general anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room, dexmedetomidine results in low incidence of EA during recovery and more stable vital signs.

摘要

目的

研究右美托咪定用于日间手术口腔科治疗患儿全身麻醉维持时,降低苏醒期躁动(EA)发生率的效果。

方法

80例在日间手术口腔科治疗并接受全身麻醉的患儿随机分为两组,A组(n = 40)和B组(n = 40)。A组患儿在插管后静脉推注右美托咪定(1.0 μg·kg⁻¹,用生理盐水稀释至10 mL),然后以0.1 - 0.4 mL·(kg·h)⁻¹的维持剂量泵注至手术结束前45分钟。B组患儿在插管后静脉推注10 mL生理盐水,然后以0.1 - 0.4 mL·(kg·h)⁻¹的维持剂量泵注至手术结束前45分钟。记录性别、年龄、体重、美国麻醉医师协会身体状况分级、围术期心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO₂)、舒芬太尼用量、手术时间、拔管时间、苏醒时间以及达到改良Aldrete评分≥12分的时间。在麻醉后恢复室对患儿的行为按四点躁动量表进行评分。

结果

与B组相比,A组在手术开始时、手术开始后10分钟和30分钟、1小时和2小时以及拔管后HR和MAP降低(P < 0.05)。A组恢复期间舒芬太尼用量和EA发生率也低于B组(P < 0.05)。A组的苏醒时间和达到改良Aldrete评分≥12分的时间比B组长(P < 0.05)。两组其他指标差异无统计学意义。

结论

右美托咪定作为日间手术口腔科治疗患儿全身麻醉维持用药,可降低苏醒期EA发生率,生命体征更稳定。

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