Javaherforooshzadeh Fatemeh, Monajemzadeh Seyed Alireza, Soltanzadeh Mansoor, Janatmakan Farahzad, Salari Amir, Saeed Hesam
Department of Anesthesia, Ahvaz Anesthesiology and Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Anesth Pain Med. 2018 Apr 28;8(2):e66959. doi: 10.5812/aapm.66959. eCollection 2018 Apr.
The aim of this study was to compare the volume of blood loss and hemodynamic changes in patients undergoing lumbar discopathy, after continuous infusions of dexmedetomidine versus remifentanil during anesthesia with controlled low blood pressure.
In this randomized double-blind clinical trial, 60 patients aged 20 to 65 years were randomly assigned to control and intervention groups. The intervention group received a continuous infusion of dexmedetomidine at 0.3 - 0.7 µg/kg/hour plus propofol at 50 - 100 µg/kg/minute. The control group was given a continuous infusion of remifentanil at 0.1 to 1 µg/kg/minute plus the same dose of propofol as above. The primary outcome was the amount of patient's bleeding during surgery, and secondary outcomes were changes in the patient's systolic blood pressure, diastolic blood pressure, mean arterial pressure, and urinary output.
Univariate and multivariate analyses of the main outcome in the control and intervention groups showed that there was no significant difference between the two drugs with regards to the volume of blood loss, mean arterial pressure, and systolic and diastolic blood pressure. Postoperative side effects were significantly lower in the intervention group (P = 0.002).
Administration of dexmedetomidine plus propofol in comparison with remifentanil plus propofol did not show any significant difference regarding blood loss and hemodynamic changes; however, it reduced some side effects after surgery and decreased analgesic requirement in the postoperative period. Taken together, the findings of this study do not support strong recommendations for dexmedetomidine infusion for all patients and the decision should be taken with caution on basis of the anesthesiologist's expert opinion and the patient's condition during surgery.
本研究旨在比较腰椎间盘疾病患者在麻醉期间控制性低血压时持续输注右美托咪定与瑞芬太尼后的失血量和血流动力学变化。
在这项随机双盲临床试验中，60例年龄在20至65岁之间的患者被随机分为对照组和干预组。干预组接受以0.3 - 0.7微克/千克/小时的速度持续输注右美托咪定加50 - 100微克/千克/分钟的丙泊酚。对照组接受以0.1至1微克/千克/分钟的速度持续输注瑞芬太尼加上述相同剂量的丙泊酚。主要结局是患者手术期间的出血量，次要结局是患者收缩压、舒张压、平均动脉压和尿量的变化。
对对照组和干预组主要结局的单因素和多因素分析表明，两种药物在失血量、平均动脉压以及收缩压和舒张压方面没有显著差异。干预组术后副作用明显更低（P = 0.002）。
与瑞芬太尼加丙泊酚相比，右美托咪定加丙泊酚在失血量和血流动力学变化方面没有显示出任何显著差异；然而，它减少了术后的一些副作用，并降低了术后镇痛需求。综上所述，本研究结果不支持对所有患者强烈推荐输注右美托咪定，应根据麻醉医生的专业意见和手术期间患者的情况谨慎做出决定。
