Chauhan Rajeev, Luthra Ankur, Sethi Sameer, Panda Nidhi, Meena Shyam Charan, Bhatia Vikas, Bloria Summit D
Department of Anaesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
Department of Radiodiagnosis, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
J Pediatr Neurosci. 2020 Oct-Dec;15(4):379-385. doi: 10.4103/jpn.JPN_167_19. Epub 2021 Jan 19.
Sodium tetradecyl sulfate (STS) sclerotherapy in pediatric patients is usually undertaken under sedation inside digital subtraction angiography (DSA) suite. These patients are day-care patients and need adequate sedation for small duration. We performed this study to compare propofol and dexmedetomidine as sedative agents in these patients.
Seventy American Society of Anesthesiologists (ASA) physical status I patients scheduled to undergo sclerotherapy for low-flow venous malformations under sedation were randomized to be administered either dexmedetomidine (Group D) or propofol (Group P). In Group D, initially 2 µg/kg of dexmedetomidine was administered over 10min (or till attainment of a Ramsay sedation score [RSS] of 5), followed by an infusion at the rate of 0.3 µg/kg/h. In Group P, propofol 1mg/kg bolus followed by an infusion at 100 µg/kg/min was administered, titrated to an RSS of 5. We measured intraoperative heart rate, blood pressure, respiratory rate, duration of procedure, and incidence of arterial desaturation, bradycardia, and respiratory depression in the two groups.
All the patients in both groups completed the procedure. The mean anesthesia time was significantly longer in Group D. Intraoperative heart rates remained comparable in the two groups, whereas systolic and diastolic BP were significantly higher in Group D throughout the procedure. No patient in Group D experienced arterial desaturation, whereas five patients in Group P reported a SpO of <90%.
Both propofol and dexmedetomidine can be used for administering sedation in pediatric patients undergoing sclerotherapy for superficial venous malformations in DSA suite. Although propofol provides a rapid onset and reduced duration of action, dexmedetomidine provides reduced episodes of arterial desaturation and respiratory depression.
小儿患者的十四烷基硫酸钠（STS）硬化治疗通常在数字减影血管造影（DSA）室镇静下进行。这些患者为日间手术患者，需要在短时间内进行充分镇静。我们开展本研究以比较丙泊酚和右美托咪定作为这些患者的镇静剂。
将70例美国麻醉医师协会（ASA）身体状况为I级、计划在镇静下接受低流量静脉畸形硬化治疗的患者随机分为右美托咪定组（D组）或丙泊酚组（P组）。D组最初在10分钟内给予2μg/kg右美托咪定（或直至达到 Ramsay 镇静评分[RSS]为5），随后以0.3μg/kg/h的速率输注。P组给予1mg/kg丙泊酚推注，随后以100μg/kg/min的速率输注，滴定至RSS为5。我们测量了两组患者术中的心率、血压、呼吸频率、手术持续时间以及动脉血氧饱和度降低、心动过缓和呼吸抑制的发生率。
两组所有患者均完成手术。D组的平均麻醉时间明显更长。两组术中心率保持相当，而整个手术过程中D组的收缩压和舒张压明显更高。D组无患者出现动脉血氧饱和度降低，而P组有5例患者报告SpO<90%。
丙泊酚和右美托咪定都可用于DSA室中接受浅表静脉畸形硬化治疗的小儿患者的镇静。虽然丙泊酚起效迅速且作用时间缩短，但右美托咪定可减少动脉血氧饱和度降低和呼吸抑制的发作。
