Nolan Patrick J, Delgadillo Jeffrey A, Youssef Joseph M, Freeman Katherine, Jones Jennifer L, Chehrehsa Arian
Assistant Professor, Division of Oral and Maxillofacial Surgery, Department of Dentistry, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
Resident, Division of Oral and Maxillofacial Surgery, Department of Dentistry, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
J Oral Maxillofac Surg. 2020 Oct;78(10):1704-1716. doi: 10.1016/j.joms.2020.05.015. Epub 2020 May 18.
Propofol and fentanyl can cause airway obstruction and respiratory depression when used together for intravenous sedation. This study investigated whether dexmedetomidine and midazolam would decrease respiratory events requiring intervention during deep sedation compared with propofol, fentanyl, and midazolam.
A prospective, randomized, double-blinded, controlled trial was designed to assess 2 intravenous treatment groups during third molar surgery. Patients were randomized into 2 groups. The control group (group P) received 0.8 μg/kg of fentanyl followed by propofol infusion at 125 μg/kg per minute over a 10-minute period with intraoperative boluses of 0.1 μg/kg. The study group (group D) received dexmedetomidine bolus infusion of 1 μg/kg over a 10-minute period followed by maintenance infusion at 0.5 μg/kg per hour. Both groups were given 0.03 mg/kg of midazolam before infusion. Scorers, masked to group, viewed the procedure remotely and evaluated the primary outcome variable of respiratory events requiring intervention. Secondary outcome variables evaluated by the scorers included the Behavioral Pain Scale for non-intubated patients at initial injection, cooperation score at 5 and 15 minutes, and time to ambulation and discharge. Patient satisfaction and hemodynamic stability were measured. The difference between groups regarding the occurrence of respiratory events was tested using the Fisher exact test, and mixed-effects models were used to compare repeated vital signs.
The sample was composed of 141 patients randomly assigned to either group P (n = 67) or group D (n = 74). No statistically significant differences in the distribution of study variables were found between groups at baseline. A statistically significant difference in respiratory events requiring deliberate intervention existed between group P (25.4%) and group D (2.7%) (P < .0001). No statistically significant difference was found between groups for Behavioral Pain Scale score, cooperation score, time to ambulation or discharge, and patient satisfaction.
Using dexmedetomidine and midazolam for outpatient surgery resulted in fewer respiratory events requiring deliberate intervention compared with propofol, fentanyl, and midazolam. Ambulation and discharge times were not prolonged using dexmedetomidine.
丙泊酚和芬太尼联合用于静脉镇静时可导致气道梗阻和呼吸抑制。本研究调查了与丙泊酚、芬太尼和咪达唑仑相比，右美托咪定和咪达唑仑在深度镇静期间是否会减少需要干预的呼吸事件。
设计了一项前瞻性、随机、双盲、对照试验，以评估第三磨牙手术期间的2个静脉治疗组。患者被随机分为2组。对照组（P组）先静脉注射0.8μg/kg芬太尼，随后在10分钟内以每分钟125μg/kg的速度输注丙泊酚，并在术中追加0.1μg/kg的剂量。研究组（D组）在10分钟内静脉推注1μg/kg右美托咪定，随后以每小时0.5μg/kg的速度持续输注。两组在输注前均给予0.03mg/kg的咪达唑仑。评分者在不知道分组情况的前提下，远程观看手术过程并评估需要干预的呼吸事件这一主要结局变量。评分者评估的次要结局变量包括初次注射时非插管患者的行为疼痛量表评分、5分钟和15分钟时的合作评分、下床活动和出院时间。测量患者满意度和血流动力学稳定性。使用Fisher精确检验比较两组间呼吸事件的发生率差异，并使用混合效应模型比较重复测量的生命体征。
样本由141例患者组成，随机分为P组（n = 67）或D组（n = 74）。两组在基线时研究变量的分布无统计学显著差异。P组（25.4%）和D组（2.7%）在需要进行刻意干预的呼吸事件方面存在统计学显著差异（P <.0001）。两组在行为疼痛量表评分、合作评分、下床活动或出院时间以及患者满意度方面均未发现统计学显著差异。
与丙泊酚、芬太尼和咪达唑仑相比，门诊手术使用右美托咪定和咪达唑仑导致需要刻意干预的呼吸事件更少。使用右美托咪定并未延长下床活动和出院时间。
