Department of Anesthesiology, Yao Tokushukai General Hospital, 1-17, Wakakusamachi, Yao City, Osaka, 581-0011, Japan.
J Anesth. 2019 Apr;33(2):266-272. doi: 10.1007/s00540-019-02612-w. Epub 2019 Jan 17.
Carotid artery stenosis is a major risk factor for ischemic stroke. Carotid endarterectomy protects patients with severe atherosclerotic carotid artery stenosis against stroke. In such patients, arterial blood pressure is often difficult to control and perioperative hemodynamic instability is associated with high morbidity and mortality after carotid endarterectomy. We performed a randomized double-blind placebo-control trial to evaluate the effects of low-dose dexmedetomidine on hemodynamic stability during the emergence and the recovery phases of general anesthesia in patients undergoing carotid endarterectomy.
Forty-seven patients (68-84 years) were randomly assigned to receive either dexmedetomidine (DEX group) or 0.9% saline (control group). Infusion of dexmedetomidine 1.0 µg/kg/hr for 1 h, followed by 0.2 µg/kg/hr or the same dose of saline was started after carotid artery declamping in the DEX and in the control group, respectively. At the end of surgery, nicardipine was used to maintain systolic arterial pressure within 20% of preoperative values. We compared the maximum dose of nicardipine, time to extubation, plasma catecholamine levels, arterial blood gases, the Richmond Agitation Sedation Scales, visual analogue scale (VAS) in the postanesthesia care unit, and adverse events within 30-days between the control and Dex groups.
The baseline clinical characteristics were similar in the two groups. The maximum dose of nicardipine (p = 0.021), plasma norepinephrine level (p = 0.033), sedation score and VAS were significantly lower in the Dex group than the control group. There were no differences between the two groups regarding time to extubation, arterial blood gases, and adverse events.
Low-dose dexmedetomidine improves hemodynamic stability during emergence and recovery from general anesthesia in patients receiving carotid endarterectomy.
UMIN000010607.
颈动脉狭窄是缺血性卒中的一个主要危险因素。颈动脉内膜切除术可预防严重动脉粥样硬化性颈动脉狭窄患者发生卒中。此类患者的动脉血压通常难以控制，且围手术期血流动力学不稳定与颈动脉内膜切除术后的高发病率和高死亡率相关。我们进行了一项随机、双盲、安慰剂对照试验，以评估小剂量右美托咪定对颈动脉内膜切除术患者全麻苏醒和恢复期血流动力学稳定性的影响。
47 名（68-84 岁）患者被随机分为右美托咪定（DEX 组）或 0.9%生理盐水（对照组）组。在夹闭颈动脉后，DEX 组和对照组分别开始输注右美托咪定 1.0μg/kg/hr 持续 1 小时，然后输注 0.2μg/kg/hr 或相同剂量的生理盐水。手术结束时，使用尼卡地平将收缩压维持在术前值的 20%以内。我们比较了两组间尼卡地平的最大剂量、拔管时间、血浆儿茶酚胺水平、动脉血气、Richmond 躁动镇静量表、麻醉后恢复室中的视觉模拟评分（VAS）以及 30 天内的不良事件。
两组的基线临床特征相似。DEX 组的尼卡地平最大剂量（p=0.021）、血浆去甲肾上腺素水平（p=0.033）、镇静评分和 VAS 均显著低于对照组。两组间拔管时间、动脉血气和不良事件无差异。
小剂量右美托咪定可改善颈动脉内膜切除术患者全麻苏醒和恢复期的血流动力学稳定性。
UMIN000010607。
