From the Department of Anesthesiology (L.U.E., J.S., D.P.D.) Department of Epidemiology and Biostatistics (J.C.W.) State University of New York Downstate Medical Center (D.J.M., M.T.S.), Brooklyn, New York.
Anesthesiology. 2019 Aug;131(2):279-286. doi: 10.1097/ALN.0000000000002809.
Enhanced recovery protocols employ various approaches to minimize detrimental side effects of anesthetizing agents. The authors tested the hypothesis that adding low-dose dexmedetomidine to propofol for anesthesia in ambulatory colonoscopies, compared with propofol alone, would lower the propofol requirement, improve the intra-procedure hemodynamic state, and not increase time-to-discharge.
In this noninferiority, double-blind, randomized controlled trial, patients having colonoscopies received total IV anesthesia either with propofol and placebo (n = 50), or propofol and a bolus dose of dexmedetomidine, 0.3 μg/kg (n = 51). Additional propofol was administered to maintain a Bispectral Index score of 60. Following the procedure, readiness for discharge was assessed regularly using the Modified Post Anesthetic Discharge Scoring System until discharge criteria were met. The primary outcome was the percentage of patients meeting discharge criteria within 30 min from procedure end-time.
Twenty-six of 51 (51%) patients receiving propofol-dexmedetomidine were ready for discharge by 30 min from procedure end time, compared with 44 of 50 (88%) receiving propofol (P < 0.001). Propofol consumption was lower in subjects receiving propofol-dexmedetomidine (140 μg · kg(-1) · min(-1)) compared to those receiving propofol (180 μg · kg(-1) · min(-1)) with P = 0.011. The lowest mean arterial pressure decreased further from baseline in those receiving propofol-dexmedetomidine (-30%; mean decrease -30 ±10.5 mmHg) compared to propofol (-21%; mean decrease, -22 ± 14.2 mmHg) with P = 0.003. There was no difference in incidence of bradycardia, with sustained bradycardia occurring in 3 of 51 (6%) patients receiving propofol-dexmedetomidine compared to 1 of 50 (2%) patients receiving propofol (P = 0.62). No apnea episodes requiring positive-pressure ventilation occurred in either group.
For anesthesia in ambulatory colonoscopy, combining low-dose dexmedetomidine with propofol delayed discharge readiness and provoked hypotension compared to propofol alone.
强化恢复方案采用各种方法来最小化麻醉剂的有害副作用。作者测试了以下假说：与单独使用丙泊酚相比，在门诊结肠镜检查中添加低剂量右美托咪定（dexmedetomidine）至丙泊酚麻醉中，将降低丙泊酚的需求，改善术中血流动力学状态，并且不会增加出院时间。
在这项非劣效性、双盲、随机对照试验中，接受结肠镜检查的患者接受全身静脉麻醉，分别使用丙泊酚和安慰剂（n = 50）或丙泊酚和右美托咪定 0.3μg/kg 的推注剂量（n = 51）。为了维持脑电双频指数（Bispectral Index）评分 60，给予额外的丙泊酚。在手术结束后，使用改良麻醉后出院评分系统（Modified Post Anesthetic Discharge Scoring System）定期评估出院准备情况，直到达到出院标准。主要结局是从手术结束时间起 30 分钟内达到出院标准的患者百分比。
在丙泊酚-右美托咪定组，有 26 名（51%）患者在手术结束后 30 分钟内准备好出院，而丙泊酚组有 44 名（88%）患者（P < 0.001）。与接受丙泊酚的患者相比，接受丙泊酚-右美托咪定的患者（140μg·kg-1·min-1）的丙泊酚消耗量更低（P = 0.011）。与接受丙泊酚的患者相比，接受丙泊酚-右美托咪定的患者的平均动脉压从基线下降得更低（30%；平均下降 30±10.5mmHg）（P = 0.003）。两组间心动过缓的发生率没有差异，接受丙泊酚-右美托咪定的患者中有 3 名（6%）发生持续性心动过缓，而接受丙泊酚的患者中有 1 名（2%）（P = 0.62）。两组均未发生需要正压通气的呼吸暂停发作。
在门诊结肠镜检查中，与单独使用丙泊酚相比，将低剂量右美托咪定与丙泊酚联合使用会延迟出院准备，并引起低血压。
