静脉注射右美托咪定进行术前用药可降低麻醉儿童顺利气管拔管所需的七氟醚最低肺泡浓度：一项随机临床试验。
Intravenous dexmedetomidine pre-medication reduces the required minimum alveolar concentration of sevoflurane for smooth tracheal extubation in anesthetized children: a randomized clinical trial.
作者信息
Di Meiqin, Yang Zhuqing, Qi Dansi, Lai Hongyan, Wu Junzheng, Liu Huacheng, Ye Xuefei, ShangGuan Wangning, Lian Qingquan, Li Jun
机构信息
Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, No. 109 Xueyuan Western Road, Wenzhou, 325027, China.
Department of Anesthesiology, The Fourth Affiliated Hospital Zhejiang University School of Medicine, N1 Shangcheng Road, Yiwu, Zhejiang Province, People's Republic of China.
出版信息
BMC Anesthesiol. 2018 Jan 17;18(1):9. doi: 10.1186/s12871-018-0469-9.
BACKGROUND
It has been known that Dexmedetomidine pre-medication enhances the effects of volatile anesthetics, reduces the need of sevoflurane, and facilitates smooth extubation in anesthetized children. This present study was designed to determine the effects of different doses of intravenous dexmedetomidine pre-medication on minimum alveolar concentration of sevoflurane for smooth tracheal extubation (MAC) in anesthetized children.
METHODS
A total of seventy-five pediatric patients, aged 3-7 years, ASA physical status I and II, and undergoing tonsillectomy were randomized to receive intravenous saline (Group D), dexmedetomidine 1 μg∙kg (Group D), or dexmedetomidine 2 μg∙kg (Group D) approximately 10 min before anesthesia start. Sevoflurane was used for anesthesia induction and anesthesia maintenance. At the end of surgery, the initial concentration of sevoflurane for smooth tracheal extubation was determined according to the modified Dixon's "up-and-down" method. The starting sevoflurane for the first patient was 1.5% in Group D, 1.0% in Group D, and 0.8% in Group D, with subsequent 0.1% up or down in next patient based on whether smooth extubation had been achieved or not in current patient. The endotreacheal tube was removed after the predetermined concentration had been maintained constant for ten minutes. All responses ("smooth" or "not smooth") to tracheal extubation and respiratory complications were assessed.
RESULTS
MAC values of sevoflurane in Group D (0.51 ± 0.13%) was significantly lower than in Group D (0.83 ± 0.10%; P < 0.001), the latter being significantly lower than in Group D (1.40 ± 0.12%; P < 0.001). EC values of sevoflurane were 0.83%, 1.07%, and 1.73% in Group D, Group D, and Group D, respectively. No patient in the current study had laryngospasm.
CONCLUSION
Dexmedetomidine decreased the required MAC values of sevoflurane to achieve smooth extubation in a dose-dependent manner. Intravenous dexmedetomidine 1 μg∙kg and 2 μg∙kg pre-medication decreased MAC by 41% and 64%, respectively.
TRIAL REGISTRATION
Chinese Clinical Trial Registry (ChiCTR): ChiCTR-IOD-17011601 , date of registration: 09 Jun 2017, retrospectively registered.
背景
已知右美托咪定预处理可增强挥发性麻醉剂的效果，减少七氟醚的用量，并有助于麻醉儿童顺利拔管。本研究旨在确定不同剂量静脉注射右美托咪定预处理对麻醉儿童顺利气管拔管时七氟醚最低肺泡浓度（MAC）的影响。
方法
总共75例3-7岁、ASA身体状况I级和II级且接受扁桃体切除术的儿科患者，在麻醉开始前约10分钟随机接受静脉注射生理盐水（D组）、1μg∙kg右美托咪定（D组）或2μg∙kg右美托咪定（D组）。七氟醚用于麻醉诱导和维持。手术结束时，根据改良的狄克逊“上下法”确定顺利气管拔管时七氟醚的初始浓度。D组第一位患者的起始七氟醚浓度为1.5%，D组为1.0%，D组为0.8%，随后根据当前患者是否实现顺利拔管，下一位患者的浓度上下调整0.1%。在预定浓度维持恒定10分钟后拔除气管导管。评估所有对气管拔管的反应（“顺利”或“不顺利”）及呼吸并发症。
结果
D组七氟醚的MAC值（0.51±0.13%）显著低于D组（0.83±0.10%；P<0.001），后者显著低于D组（1.40±0.12%；P<0.001）。D组、D组和D组七氟醚的EC值分别为0.83%、1.07%和1.73%。本研究中无患者发生喉痉挛。
结论
右美托咪定以剂量依赖的方式降低了实现顺利拔管所需要的七氟醚MAC值。静脉注射1μg∙kg和2μg∙kg右美托咪定预处理分别使MAC降低了41%和64%。
试验注册
中国临床试验注册中心（ChiCTR）：ChiCTR-IOD-17011601，注册日期：2017年6月9日，回顾性注册。
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