Chilkoti Geetanjali T, Karthik Ganeshan, Rautela Rajesh
Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India.
J Anaesthesiol Clin Pharmacol. 2020 Jan-Mar;36(1):72-77. doi: 10.4103/joacp.JOACP_184_17. Epub 2020 Feb 18.
Dexmedetomidine is a α2-agonist with sedative, sympatholytic and analgesic properties and hence, it can be a very useful adjuvant in anesthesia as stress response buster, sedative and analgesic. We aimed to evaluate the effects of low dose dexmedetomidine infusion (0.5 mcg/kg/h) on postoperative analgesic efficacy along with the perioperative hemodynamic changes in patients undergoing laparoscopic cholecystectomy.
Eighty patients of American Society of Anesthesiologists (ASA) physical grades I and II undergoing laparoscopic cholecystectomy were randomly allocated into two groups of 40 patients each. Group I (Normal Saline group) patients received normal saline and group II (Dexmedetomidine group) patients received dexmedetomidine infusion at 0.5 mcg/kg/h respectively, starting 15 min before induction and continued till the end of surgery. Parameters noted were heart rate, mean arterial pressure, oxygen saturation, post-operative pain was evaluated using VAS and analgesic requirement. Statistical tests such as ANOVA test for continuous variables, test for intergroup comparison, and Chi-square test for discrete values were applied.
Post-operative efficacy was found to be limited in the dexmedetomidine group in terms of VAS score. The analgesic requirement in 24-hour was observed to be reduced in dexmedetomidine group when compared to the NS group; however, not statistically significant. In group NS, significant hemodynamic stress response was seen following laryngoscopy, tracheal intubation, creation of pneumoperitoneum and extubation. On intergroup comparison, the hemodynamic response was significantly attenuated in the dexmedetomidine group when compared to the NS group. No significant side effects were noted.
Dexmedetomidine IV in an infusion dose of 0.5 μg/kg/hr is effective in providing postoperative analgesia in terms of significant reduction in analgesic consumption in 24 hours and in addition to the effective obtundation of the pneumoperitoneum-induced hemodynamic changes.
右美托咪定是一种具有镇静、抗交感神经和镇痛特性的α2受体激动剂，因此，作为应激反应抑制剂、镇静剂和镇痛药，它在麻醉中可能是一种非常有用的辅助药物。我们旨在评估低剂量右美托咪定输注（0.5微克/千克/小时）对腹腔镜胆囊切除术患者术后镇痛效果以及围手术期血流动力学变化的影响。
80例美国麻醉医师协会（ASA）身体状况分级为I级和II级的行腹腔镜胆囊切除术患者被随机分为两组，每组40例。I组（生理盐水组）患者接受生理盐水，II组（右美托咪定组）患者分别在诱导前15分钟开始以0.5微克/千克/小时的速度输注右美托咪定，持续至手术结束。记录的参数包括心率、平均动脉压、血氧饱和度，使用视觉模拟评分法（VAS）评估术后疼痛以及镇痛需求。应用了诸如连续变量的方差分析检验、组间比较检验以及离散值的卡方检验等统计检验方法。
就VAS评分而言，右美托咪定组术后效果有限。与生理盐水组相比，右美托咪定组24小时内的镇痛需求有所减少；然而，差异无统计学意义。在生理盐水组中，喉镜检查、气管插管、气腹形成和拔管后出现了显著的血流动力学应激反应。组间比较时，与生理盐水组相比，右美托咪定组的血流动力学反应明显减弱。未观察到明显的副作用。
以0.5微克/千克/小时的输注剂量静脉注射右美托咪定，在24小时内显著减少镇痛药物消耗方面以及有效减轻气腹引起的血流动力学变化方面，对提供术后镇痛是有效的。
