Vijayan Naveen K, Talwar Vandana, Dayal Madhu
Department of Anaesthesia, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Anesth Essays Res. 2019 Jul-Sep;13(3):515-521. doi: 10.4103/aer.AER_86_19.
In this study, we evaluated the efficacy of premedication with dexmedetomidine, pregabalin, and dexmedetomidine-pregabalin combination for attenuating the haemodynamic stress response to laryngoscopy and intubation and pneumoperitoneum (primary outcome), and for reducing anaesthetic requirement (secondary outcome) in patients undergoing laparoscopic cholecystectomy.
Ninety ASA physical status classes I-II patients, between 18 to 65 years of age, of either sex, scheduled to undergo laparoscopic cholecystectomy were included in this randomised double blind study. Morbidly obese patients and those with history of hypertension, cardiac, renal, hepatic, endocrine or pulmonary dysfunction were excluded. Patients were randomized to three groups - Group P- received oral pregabalin (150 mg) one hour before induction and 100 mL of i.v normal saline (0.9%) over 10 minutes, 10 minutes before induction; Group D- received i.v dexmedetomidine (1 μg.kg) prepared in 100 mL of 0.9% normal saline and given over 10 minutes, 10 minutes before induction, and an oral placebo tablet one hour before induction; and Group C-received a combination of oral pregabalin 75 mg one hour before induction, and IV dexmedetomidine (0.5 μg.kg) prepared in 100 mL of 0.9% normal saline over 10 minutes, 10 minutes before induction.
Dexmedetomidine significantly attenuated the stress response to laryngoscopy and intubation and pneumoperitoneum and reduced anaesthetic requirement as compared to the other two groups. Dexmedetomidine was associated with significantly lower mean arterial pressures and higher sedation score in the preoperative and postoperative period and significantly lower heart rate and arterial pressures and reduced anaesthetic requirement in the intraoperative period as compared to the other groups.
Dexmedetomidine is a valuable adjunct to the technique of balanced anaesthesia for maintaining haemodynamic stability.
在本研究中，我们评估了右美托咪定、普瑞巴林及右美托咪定 - 普瑞巴林联合用药作为术前用药，对减轻接受腹腔镜胆囊切除术患者喉镜检查及气管插管和气腹引起的血流动力学应激反应（主要结局）以及减少麻醉药物需求量（次要结局）的效果。
本随机双盲研究纳入了90例年龄在18至65岁、ASA身体状况分级为I-II级、计划行腹腔镜胆囊切除术的患者，男女不限。排除病态肥胖患者以及有高血压、心脏、肾脏、肝脏、内分泌或肺部功能障碍病史的患者。患者被随机分为三组：P组在诱导前1小时口服普瑞巴林（150 mg），并在诱导前10分钟经10分钟静脉输注100 mL 0.9%的生理盐水；D组在诱导前10分钟经10分钟静脉输注用100 mL 0.9%生理盐水配制的右美托咪定（1 μg/kg），并在诱导前1小时口服安慰剂片；C组在诱导前1小时口服75 mg普瑞巴林，并在诱导前10分钟经10分钟静脉输注用100 mL 0.9%生理盐水配制的右美托咪定（0.5 μg/kg）。
与其他两组相比，右美托咪定显著减轻了喉镜检查及气管插管和气腹引起的应激反应，并减少了麻醉药物需求量。与其他组相比，右美托咪定在术前和术后平均动脉压显著更低，镇静评分更高，在术中心率、动脉压显著更低，麻醉药物需求量减少。
右美托咪定是维持血流动力学稳定的平衡麻醉技术的一种有价值的辅助药物。
