右美托咪定对全静脉麻醉下机器人辅助腹腔镜根治性前列腺切除术患者眼内压的影响：一项随机、双盲、安慰剂对照的临床试验。

Effect of dexmedetomidine on intraocular pressure in patients undergoing robot-assisted laparoscopic radical prostatectomy under total intravenous anesthesia: A randomized, double blinded placebo controlled clinical trial.

机构信息

Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon City, Ehime 790-0295, Japan.

Matsuyama Red Cross Hospital, 1 Bunkyo cho, Matsuyama City, Ehime 790-8524, Japan.

出版信息

J Clin Anesth. 2018 Sep;49:30-35. doi: 10.1016/j.jclinane.2018.06.006. Epub 2018 Jun 5.

DOI:10.1016/j.jclinane.2018.06.006

PMID:29883964

Abstract

STUDY OBJECTIVE

To study the effects of intraoperative dexmedetomidine on the intraocular pressure (IOP) in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALRP) under propofol-remifentanil anesthesia.

DESIGN

Double-blind, randomized controlled trial.

SETTING

Operating room.

PATIENTS

Forty consenting male patients aged ≥20 to <80 years with American Society of Anesthesiologists physical status classes I and II.

INTERVENTIONS

The patients were randomly assigned to either dexmedetomidine (DEX) (n = 20) or control (n = 20) group. Anesthesia was induced and maintained using propofol, remifentanil, and rocuronium. In the dexmedetomidine group, dexmedetomidine was administered at 0.4 μg/kg/h immediately after anesthesia induction until the end of the surgery, whereas normal saline was administered as placebo in the control group.

MEASUREMENTS

IOP was measured using a rebound tonometer. Time points of measuring IOP were as follows: T1: before anesthesia induction, T2: 5 min after intubation, T3: 60 min after placing patient in the Trendelenburg position, T4: 120 min after placing patient in the Trendelenburg position, T5: 180 min after placing patient in the Trendelenburg position, T6: 5 min after placing patient in a horizontal position, T7: 5 min after extubation, and T8: 30 min after extubation.

MAIN RESULTS

A linear mixed model analysis demonstrated a significant intergroup difference in IOP over time and during pneumoperitoneum in the steep Trendelenburg position. IOP at T5 was significantly lower in the dexmedetomidine group than in the control group even after post-hoc analysis in the steep Trendelenburg position periods with Bonferroni correction.

CONCLUSIONS

Dexmedetomidine combined with propofol decreases IOP in the steep Trendelenburg position during RALRP.

摘要

研究目的

研究全身麻醉下异丙酚-瑞芬太尼复合麻醉行机器人辅助腹腔镜前列腺根治术（RALRP）时，术中给予右美托咪定对患者眼内压（IOP）的影响。

设计

双盲、随机对照试验。

设置

手术室。

患者

40 名年龄≥20 岁且＜80 岁、美国麻醉医师协会（ASA）分级为Ⅰ级或Ⅱ级的男性患者。

干预措施

患者被随机分配至右美托咪定（DEX）组（n=20）或对照组（n=20）。麻醉诱导和维持采用异丙酚、瑞芬太尼和罗库溴铵。DEX 组在麻醉诱导后立即给予右美托咪定 0.4μg/kg/h，直至手术结束，而对照组给予生理盐水作为安慰剂。

测量指标

使用回弹眼压计测量 IOP。测量 IOP 的时间点如下：T1：麻醉诱导前，T2：插管后 5min，T3：患者置于头高脚低位 60min，T4：患者置于头高脚低位 120min，T5：患者置于头高脚低位 180min，T6：患者置于水平位后 5min，T7：拔管后 5min，T8：拔管后 30min。