Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland).
Med Sci Monit. 2019 Jan 13;25:381-388. doi: 10.12659/MSM.912517.
BACKGROUND The aim of this study was to investigate the median effective dose (ED50) of intranasal dexmedetomidine for echocardiography in children with Kawasaki disease who had a history of repeated sedation. MATERIAL AND METHODS There were 73 pediatric Kawasaki disease patients aged 1 to 36 months enrolled in this study who had American Society of Anesthesiologists (ASA) I-II, were scheduled to undergo echocardiography under sedation. They were assigned to 2 groups (group A: age 1-18 months, and group B: age 19-36 months). Intranasal dexmedetomidine was administered before echocardiography. The dose of intranasal dexmedetomidine was determined with the up-down sequential allocation, and the initial dose was 2 μg/kg with an increment/decrement of 0.2 μg/kg. The ED50 of intranasal dexmedetomidine for sedation was determined with the up-and-down method of Dixon and Massey and probit regression. The time to effective sedation, time to regaining consciousness, vital signs, oxygen saturation, echocardiographic examination time, clinical side-effects, and characteristics of regaining consciousness were recorded and compared. RESULTS The ED50 of intranasal dexmedetomidine for sedation was 2.184 μg/kg (95% CI, 1.587-2.785) in group A and 2.313 μg/kg (95% CI, 1.799-3.426) in group B. There were no significant differences in the time to sedation and time to regaining consciousness between groups. Additionally, change in hemodynamic and hypoxemia were not noted in both groups. CONCLUSIONS The ED50 of intranasal dexmedetomidine was determined in children with Kawasaki disease who had a history of repeated sedation to be appropriate for repeated-routine sedation of echocardiographic examination in pediatric patients. The ED50 of intranasal dexmedetomidine for echocardiography in this circumstance is similar to that in children receiving initial sedation.
本研究旨在探讨有重复镇静史的川崎病患儿行超声心动图检查时，经鼻给予右美托咪定的半数有效剂量（ED50）。
本研究纳入 73 例年龄 1 至 36 个月、美国麻醉医师协会（ASA）分级 I-II 级、拟在镇静下接受超声心动图检查的川崎病患儿。将其分为 2 组（A 组：年龄 1-18 个月；B 组：年龄 19-36 个月）。于行超声心动图检查前经鼻给予右美托咪定。采用上下序贯分配法确定右美托咪定经鼻给药剂量，初始剂量为 2μg/kg，增量/减量为 0.2μg/kg。采用 Dixon 和 Massey 上下法和概率单位回归法确定右美托咪定经鼻镇静的 ED50。记录并比较两组患儿的有效镇静时间、意识恢复时间、生命体征、血氧饱和度、超声心动图检查时间、临床不良反应以及意识恢复特征。
A 组右美托咪定经鼻镇静的 ED50 为 2.184μg/kg（95%CI：1.587-2.785），B 组为 2.313μg/kg（95%CI：1.799-3.426）。两组患儿镇静起效时间和意识恢复时间比较，差异均无统计学意义（均 P>0.05）。两组患儿均未出现血流动力学改变和低氧血症。
有重复镇静史的川崎病患儿行超声心动图检查时，经鼻给予右美托咪定的 ED50 适宜用于儿科患者重复常规镇静下的超声心动图检查。在这种情况下，经鼻给予右美托咪定的 ED50 与初次镇静的儿童相似。
