Perika Tilak, Gupta Suman Lata, Elakkumanan Lenin Babu, Kattimani Shivanand
Department of Anaesthesiology and Cirtical Care, JIPMER, Puducherry, India.
Department of Psychiatry, JIPMER, Puducherry, India.
J Anaesthesiol Clin Pharmacol. 2019 Apr-Jun;35(2):236-241. doi: 10.4103/joacp.JOACP_390_17.
Early psychomotor recovery is an essential part of day care surgery which depends on brain integration of motor and sensory co-ordination. Even though dexmedetomidine is commonly used for day care procedures, the recovery profile was not studied. Hence, this study was designed to evaluate the psychomotor recovery of sedation with dexmedetomidine during spinal anesthesia.
Sixty-six patients were included. Group D received dexmedetomidine 0.5 μg/kg (loading dose) followed by 0.2-1 μg/kg/hour. Group received propofol infusion of 25-100 μg/kg/minute. Psychomotor recovery was assessed by finger-tapping, manual dexterity, visual spatial memory capacity, and pen and paper tests. Psychomotor tasks were given to the patients postoperatively at every 30 minutes for 2 hours followed by every hour up to 4 hours after surgery. Distribution of patients, age, weight, duration of surgery, and the level of sensory blockade was compared using independent -test. Student's -test has been used to find the significance of parameters such as heart rate, mean arterial pressure, oxygen saturation (SpO), psychomotor recovery between two groups. < 0.05 was considered as significant.
The motor recovery using finger tapping test was faster in Group D than Group (73.94 ± 42.13 vs 101.21 ± 37.98 minutes, P-value = 0.007). Motor recovery using peg board test was faster in Group than Group D (82.12 ± 40.37 vs 99.39 ± 43.08 minutes, P-value = 0.098). Visual spatial capacity memory test and pen and paper test were unaffected.
We conclude that patients who received dexmedetomidine showed earlier recovery with finger tapping test. Hence, we suggest to use dexmedetomidine for complete psychomotor recovery and fast-track discharging of the patient after spinal anesthesia.
早期精神运动功能恢复是日间手术的重要组成部分，它依赖于大脑对运动和感觉协调的整合。尽管右美托咪定常用于日间手术，但尚未对其恢复情况进行研究。因此，本研究旨在评估脊髓麻醉期间使用右美托咪定镇静后的精神运动功能恢复情况。
纳入66例患者。D组给予右美托咪定0.5μg/kg（负荷剂量），随后以0.2 - 1μg/kg/小时的速度输注。对照组给予丙泊酚以25 - 100μg/kg/分钟的速度输注。通过手指敲击、手部灵巧性、视觉空间记忆能力以及纸笔测试来评估精神运动功能恢复情况。术后每30分钟对患者进行精神运动任务测试，持续2小时，之后在术后4小时内每小时进行一次测试。使用独立样本t检验比较患者分布、年龄、体重、手术时长以及感觉阻滞水平。采用学生t检验来确定两组之间心率、平均动脉压、血氧饱和度（SpO）、精神运动功能恢复等参数的显著性差异。P < 0.05被认为具有显著性。
使用手指敲击测试评估，D组的运动恢复比对照组更快（73.94 ± 42.13分钟 vs 101.21 ± 37.98分钟，P值 = 0.007）。使用钉板测试评估，对照组的运动恢复比D组更快（82.12 ± 40.37分钟 vs 99.39 ± 43.08分钟，P值 = 0.098）。视觉空间能力记忆测试和纸笔测试未受影响。
我们得出结论，接受右美托咪定的患者在手指敲击测试中显示出更早的恢复。因此，我们建议在脊髓麻醉后使用右美托咪定以实现完全的精神运动功能恢复并使患者快速出院。
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