Kurhekar Pranjali, Vinod Krishnagopal, Rajarathinam Buddhan, Dhiviya Krishna J Shesha, Raghuraman M S
Department of Anesthesiology, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, India.
Department of Pain Medicine, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, India.
Saudi J Anaesth. 2018 Jan-Mar;12(1):61-66. doi: 10.4103/sja.SJA_419_17.
Emergence agitation (EA) in nasal surgeries is seen in around 22% of patients, which can go to dangerous levels. Dexmedetomidine is effective in prevention of EA in such patients. Midazolam given as premedication fails to prevent EA due to its short half-life. In this study, we compared efficacy of dexmedetomidine and midazolam by intravenous infusion for prevention of EA in adult nasal surgeries.
Seventy patients belonging to American society of anesthesiologist Status I and II, between 18 and 60 years of age posted for elective nasal surgeries were randomly divided into two groups. Group D received intravenous dexmedetomidine 0.5 mcg/kg over 15 min followed by 0.1 mcg/kg/h. Group M received intravenous midazolam 0.02 mg/kg over 15 min followed by 0.02 mg/kg/h. EA scores, emergence times, and hemodynamic parameters were monitored and compared between the groups. Statistical analysis was done by independent -test, Mann-Whitney U-test, and Chi-square test as applicable.
Incidence of EA was comparable between the groups ( = 0.23). Two patients in midazolam group developed dangerous agitation while none in dexmedetomidine group. Patients in midazolam group (12.4%) were agitated even in postoperative period, which was not seen with dexmedetomidine group. Hypotension and bradycardia were seen more in dexmedetomidine group.
Efficacy of midazolam when given as an intravenous infusion is comparable to dexmedetomidine in prevention of EA in nasal surgeries.
鼻部手术中约22%的患者会出现苏醒期躁动（EA），其可能达到危险程度。右美托咪定对预防此类患者的EA有效。术前给予咪达唑仑由于其半衰期短而无法预防EA。在本研究中，我们比较了静脉输注右美托咪定和咪达唑仑预防成人鼻部手术中EA的疗效。
70例年龄在18至60岁之间、美国麻醉医师协会身体状况分级为I级和II级、拟行择期鼻部手术的患者被随机分为两组。D组在15分钟内静脉输注右美托咪定0.5 mcg/kg，随后以0.1 mcg/kg/h的速度输注。M组在15分钟内静脉输注咪达唑仑0.02 mg/kg，随后以0.02 mg/kg/h的速度输注。监测并比较两组的EA评分、苏醒时间和血流动力学参数。根据适用情况，采用独立样本t检验、曼-惠特尼U检验和卡方检验进行统计分析。
两组的EA发生率相当（P = 0.23）。咪达唑仑组有2例患者出现危险的躁动，而右美托咪定组无此情况。咪达唑仑组的患者（12.4%）即使在术后仍有躁动，而右美托咪定组未见此情况。右美托咪定组出现低血压和心动过缓的情况更多。
静脉输注咪达唑仑在预防鼻部手术中EA方面的疗效与右美托咪定相当。
