Department of Anesthesiology & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India.
Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, India.
Korean J Anesthesiol. 2021 Apr;74(2):150-157. doi: 10.4097/kja.20153. Epub 2020 May 20.
Dexmedetomidine, an alpha-2 agonist, has been used for attenuation of hemodynamic response to laryngoscopy but not through the nebulized route. We evaluated the effects of preoperative dexmedetomidine nebulization on the hemodynamic response to laryngoscopy and intubation and examined the intraoperative anesthetic-analgesic requirements and recovery outcomes.
Overall, 120 American Society of Anesthesiologists I & II adult patients (of either gender) undergoing elective surgeries and requiring tracheal intubation, were randomized to receive nebulized dexmedetomidine (1 µg/kg in 3-4 ml of 0.9% saline) or 0.9% saline (3-4 ml), 30 min before anesthesia induction. Heart rate (HR) and non-invasive systolic blood pressure (SBP) were monitored for 10 min following laryngoscopy.
After laryngoscopy, linear mixed effect modelling showed significantly lower trend of increase in HR in the dexmedetomidine group versus saline (P = 0.012); however, there was no difference in the SBP changes between the two groups (P = 0.904). Induction dose of propofol (P < 0.001), intraoperative fentanyl consumption (P = 0.007), and isoflurane requirements (P = 0.013) were significantly lower in the dexmedetomidine group. There was no difference in the 2 h incidence of postoperative nausea and vomiting (PONV) (P = 0.612) or sore-throat (P = 0.741).
Nebulized dexmedetomidine at 1 µg/kg attenuated the increase in HR but not SBP following laryngoscopy and reduced the intraoperative anesthetic and analgesic consumption. There was no effect on early PONV, sore-throat, or increase in incidence of adverse effects. Nebulized dexmedetomidine may represent a favorable alternative to the intravenous route in short duration surgeries.
右美托咪定是一种 α-2 激动剂，已被用于减轻喉镜检查时的血流动力学反应，但不能通过雾化途径。我们评估了术前雾化右美托咪定对喉镜检查和插管时血流动力学反应的影响，并检查了术中麻醉-镇痛需求和恢复结果。
共有 120 名美国麻醉医师协会 I 和 II 级成年患者（无论性别）接受择期手术并需要气管插管，随机分为接受雾化右美托咪定（1 µg/kg 溶于 3-4 ml 0.9%生理盐水）或 0.9%生理盐水（3-4 ml），在麻醉诱导前 30 分钟。在喉镜检查后 10 分钟监测心率（HR）和无创收缩压（SBP）。
在喉镜检查后，线性混合效应模型显示，与生理盐水组相比，右美托咪定组 HR 的增加趋势明显较低（P = 0.012）；然而，两组之间 SBP 的变化没有差异（P = 0.904）。右美托咪定组异丙酚诱导剂量（P < 0.001）、术中芬太尼用量（P = 0.007）和异氟醚需求量（P = 0.013）明显降低。术后 2 小时恶心呕吐（PONV）（P = 0.612）或喉咙痛（P = 0.741）的发生率无差异。
1 µg/kg 的雾化右美托咪定可减轻喉镜检查后 HR 的增加，但不能减轻 SBP 的增加，并减少术中麻醉和镇痛的消耗。对早期 PONV、喉咙痛或不良反应发生率增加没有影响。雾化右美托咪定可能是短时间手术中静脉途径的替代方案。
