Anesthesiology and.
Pneumology, Centre Intégré Universitaire De Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal (CIUSSS), Montréal, Quebec, Canada.
Anesth Analg. 2019 Jan;128(1):98-106. doi: 10.1213/ANE.0000000000003633.
We hypothesized that, compared to remifentanil, dexmedetomidine used for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) performed under monitored anesthesia care (MAC) in nonintubated patients would result in fewer episodes of major respiratory adverse events (number of episodes of bradypnea, apnea or desaturation) but no difference in satisfaction with perioperative conditions.
Sixty (American Society of Anesthesiologists physical status I-III) patients scheduled to undergo EBUS-TBNA under MAC were randomized to receive either remifentanil (0.5 µg/kg IV bolus) in 10 minutes, followed by 0.05-0.25 µg/kg/min, or dexmedetomidine (0.4 µg/kg IV bolus) in 10 minutes, followed by 0.5-1.0 µg/kg/h. The primary outcome was the number of major respiratory adverse events (bradypnea, apnea, or hypoxia). The secondary outcomes included hemodynamic variables, discharge time from the postanesthesia care unit, endotracheal lidocaine use, patient's sedation using the Observer Assessment of Alertness/Sedation Scale, operative conditions, operator and patient satisfaction, pain, coughing, vocal cord mobility, recall, and nausea/vomiting.
Dexmedetomidine produced significantly fewer episodes of major respiratory events (bradypnea, apnea, or desaturation), with 0 [0-0.5] episodes versus 2 [0-5] (median [interquartile range]) (P = .001), than did remifentanil. Fewer episodes of bradypnea or apnea (dexmedetomidine: 0 [0-0] versus remifentanil: 0 [0-0.5]; P = .031), and fewer episodes of desaturation (dexmedetomidine: 0 [0-0.5] versus remifentanil: 1 [0-4]; P = .039) were recorded in the dexmedetomidine group. The time needed for patients to meet postanesthesia care unit discharge criteria (Aldrete score: 9) after EBUS-TBNA was longer in the dexmedetomidine group (10 [3-37.5] minutes) versus the remifentanil group (3 [3-5] minutes) (P < .001). No differences were observed in the 2 groups for sedation depth (Observer Assessment of Alertness/Sedation Scale), endotracheal lidocaine use, operative conditions, operator and patient satisfaction, pain, coughing, vocal cord mobility, recall, and nausea/vomiting episodes.
Dexmedetomidine resulted in fewer respiratory adverse events during EBUS-TBNA under MAC, when compared to remifentanil, with no difference in overall operative conditions. However, dexmedetomidine use was associated with delayed postoperative discharge.
我们假设，与瑞芬太尼相比，在非插管患者中，在监测麻醉护理（MAC）下进行支气管内超声引导经支气管针吸活检（EBUS-TBNA）时，使用右美托咪定可导致较少的主要呼吸不良事件发作（呼吸过缓、呼吸暂停或低氧血症发作次数），但对围手术期条件的满意度无差异。
60 例（美国麻醉医师协会身体状况 I-III 级）拟行 MAC 下 EBUS-TBNA 的患者随机分为瑞芬太尼组（静脉推注 0.5μg/kg，持续 10 分钟，随后以 0.05-0.25μg/kg/min 的速度输注）或右美托咪定组（静脉推注 0.4μg/kg，持续 10 分钟，随后以 0.5-1.0μg/kg/h 的速度输注）。主要结局为主要呼吸不良事件（呼吸过缓、呼吸暂停或低氧血症）的发作次数。次要结局包括血流动力学变量、离开麻醉后恢复室的时间、气管内利多卡因的使用、使用观察者评估警觉/镇静评分的患者镇静情况、手术条件、操作者和患者满意度、疼痛、咳嗽、声带活动度、回忆和恶心/呕吐。
与瑞芬太尼相比，右美托咪定组（0 [0-0.5] 次）显著减少了主要呼吸事件发作次数（呼吸过缓、呼吸暂停或低氧血症），（中位数[四分位距]）（P=.001）。呼吸过缓或呼吸暂停的发作次数较少（右美托咪定：0 [0-0] 次与瑞芬太尼：0 [0-0.5] 次；P=.031），以及较低的低氧血症发作次数（右美托咪定：0 [0-0.5] 次与瑞芬太尼：1 [0-4] 次；P=.039）在右美托咪定组中记录到。与瑞芬太尼组（3 [3-5] 分钟）相比，右美托咪定组（10 [3-37.5] 分钟）患者达到麻醉后恢复室出院标准（Aldrete 评分：9）所需的时间更长（P<.001）。在镇静深度（观察者评估警觉/镇静评分）、气管内利多卡因使用、手术条件、操作者和患者满意度、疼痛、咳嗽、声带活动度、回忆和恶心/呕吐发作方面，两组之间无差异。
与瑞芬太尼相比，在 MAC 下进行 EBUS-TBNA 时，右美托咪定导致呼吸不良事件减少，而手术总体条件无差异。然而，右美托咪定的使用与术后延迟出院有关。
