Xu Xianfei, Cao Yunfei, Wu Youhua, Ding Miao
Assistant Professor, Department of Anesthesiology, People's hospital of beilun district, Ningbo city, Zhejiang province, Ningbo, Zhejiang, China.
Assistant Professor, Department of Anesthesiology, People's hospital of beilun district, Ningbo city, Zhejiang province, Ningbo, Zhejiang, China.
J Oral Maxillofac Surg. 2022 Mar;80(3):443-455. doi: 10.1016/j.joms.2021.10.013. Epub 2021 Oct 30.
Light sedation rather than intravenous sedation is preferred when patients have a low heart rate and blood pressure during maxillofacial surgery. Intranasal administration of dexmedetomidine is reported to be efficacious and safe in adults. However, dexmedetomidine could be unsuitable for routine clinical use in elderly patients because many of these patients take β-blockers, which increase the cardiovascular effects of dexmedetomidine. The objectives of the study were to evaluate the sedative properties and safety of intranasal dexmedetomidine, regardless of concurrent β-blocker treatment, in elderly patients who underwent maxillofacial surgery.
This study was a retrospective analysis of 535 patients aged > 65 years (American Society of Anesthesiologists physical status I or II) who were undergoing maxillofacial surgery. Very anxious patients and those with hypertension received intranasal 1 µg/kg dexmedetomidine through an intranasal mucosal atomization device before anesthesia (local ropivacaine).
Intranasal administration of dexmedetomidine decreased the requirement for midazolam before surgery (18 of 252 vs 63 of 283, P < .0001), but increased the requirement for norepinephrine (102 of 252 vs 8 of 283, P < .0001) during or after the surgery. A combination of a β-blocker and intranasal administration of dexmedetomidine reduced the hemodynamic parameters for an extended period. Intranasal administration of dexmedetomidine resulted in bradycardia and hypotension, regardless of concurrent β-blocker treatment.
Intranasal 1 µg/kg dexmedetomidine was associated with a high sedation score during the operation, but also with bradycardia and hypotension.
在颌面部手术期间，当患者心率和血压较低时，更倾向于采用浅镇静而非静脉镇静。据报道，成人鼻内给予右美托咪定有效且安全。然而，右美托咪定可能不适用于老年患者的常规临床应用，因为许多老年患者服用β受体阻滞剂，这会增强右美托咪定的心血管效应。本研究的目的是评估在接受颌面部手术的老年患者中，无论是否同时接受β受体阻滞剂治疗，鼻内给予右美托咪定的镇静特性和安全性。
本研究是对535例年龄>65岁（美国麻醉医师协会身体状况I或II级）接受颌面部手术的患者进行的回顾性分析。非常焦虑的患者和高血压患者在麻醉（局部罗哌卡因）前通过鼻黏膜雾化装置接受1μg/kg鼻内右美托咪定。
鼻内给予右美托咪定降低了术前咪达唑仑的需求量（252例中的18例 vs 283例中的63例，P<.0001），但增加了手术期间或术后去甲肾上腺素的需求量（252例中的102例 vs 283例中的8例，P<.0001）。β受体阻滞剂与鼻内给予右美托咪定联合使用可在较长时间内降低血流动力学参数。无论是否同时接受β受体阻滞剂治疗，鼻内给予右美托咪定都会导致心动过缓和低血压。
鼻内给予1μg/kg右美托咪定在手术期间与高镇静评分相关，但也与心动过缓和低血压相关。
