Kang RyungA, Shin Young Hee, Gil Nam-Su, Oh Ye Na, Hahm Tae Soo, Jeong Ji Seon
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Paediatr Anaesth. 2018 Dec;28(12):1116-1122. doi: 10.1111/pan.13514. Epub 2018 Oct 29.
Mucopolysaccharidosis type II patients are reported to have an elevated incidence of difficult airway. Propofol is a commonly used sedative for magnetic resonance imaging in pediatric patients, but patients who receive it may exhibit dose-dependent upper airway obstruction and respiratory depression. Dexmedetomidine also provides adequate procedural sedation with a relatively low risk of airway obstruction. Accordingly, we introduced the use of dexmedetomidine in our practice to reduce the risk of airway obstruction during magnetic resonance imaging procedures.
The aim of this study was to evaluate the incidence of artificial airway interventions in patients sedated with propofol and compare it to that in patients sedated with dexmedetomidine in patients with mucopolysaccharidosis type II during magnetic resonance imaging procedures.
All mucopolysaccharidosis type II patients undergoing magnetic resonance imaging at our institution between April 2014 and February 2018 were included in this study. The patients were divided into two groups according to whether they were managed before and after the introduction of dexmedetomidine: those who were sedated with propofol (group P) and those who were sedated with dexmedetomidine (group D).
Forty-six sedations were performed in 27 patients. Artificial airway interventions were significantly more frequent during propofol-based than dexmedetomidine-based sedation: 14 of 32 (43.8%) in group P and 1 of 14 (7.1%) in group D (odds ratio, 10.11; 95% confidence interval, 1.18-86.85; P = 0.018). Time to awake and time to discharge were similar between groups. Changes in hemodynamic variables also did not significantly differ between groups.
Dexmedetomidine provides an adequate level of sedation and is associated with lower rates of artificial airway interventions compared to propofol. Therefore, dexmedetomidine may offer advantages for preserving the native airway compared to propofol when administered during magnetic resonance imaging scans in patients with mucopolysaccharidosis type II.
据报道，II型黏多糖贮积症患者出现困难气道的发生率较高。丙泊酚是儿科患者磁共振成像常用的镇静剂，但接受该药物的患者可能会出现剂量依赖性上呼吸道梗阻和呼吸抑制。右美托咪定也能提供足够的操作镇静，且气道梗阻风险相对较低。因此，我们在实践中引入右美托咪定的使用，以降低磁共振成像检查过程中气道梗阻的风险。
本研究的目的是评估II型黏多糖贮积症患者在磁共振成像检查过程中，接受丙泊酚镇静的患者与接受右美托咪定镇静的患者人工气道干预的发生率，并进行比较。
纳入2014年4月至2018年2月在我院接受磁共振成像检查的所有II型黏多糖贮积症患者。根据右美托咪定引入前后进行分组：接受丙泊酚镇静的患者（P组）和接受右美托咪定镇静的患者（D组）。
27例患者共进行了46次镇静。基于丙泊酚的镇静期间人工气道干预明显比基于右美托咪定的镇静更频繁：P组32例中有14例（43.8%），D组14例中有1例（7.1%）（优势比，10.11；95%置信区间，1.18 - 86.85；P = 0.018）。两组之间的苏醒时间和出院时间相似。两组之间血流动力学变量的变化也无显著差异。
与丙泊酚相比，右美托咪定能提供足够的镇静水平，且人工气道干预率较低。因此，在II型黏多糖贮积症患者进行磁共振成像扫描时，与丙泊酚相比，右美托咪定在保留天然气道方面可能具有优势。
