Wu Jinhong, Han Yuan, Lu Yu, Zhuang Yan, Li Wenxian, Jia Ji'e
Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China.
Front Pharmacol. 2022 Feb 8;13:760916. doi: 10.3389/fphar.2022.760916. eCollection 2022.
There are many benefits of administering dexmedetomidine perioperatively. The pharmacokinetics (PK) and pharmacodynamics (PD) of intravenous, intranasal and oral dexmedetomidine that was administered before anesthesia were compared in this study, and the effects of dexmedetomidine on the surgical field visibility in tympanoplasty was evaluated. A single-blind, randomized controlled trial was conducted in a university-affiliated hospital where 45 patients who underwent tympanoplasty under general anesthesia were randomly allocated into three groups. Dexmedetomidine was administered by intravenous infusion at 0.8 μg.kg for 10 min, intranasal instillation at a drop rate of 1 μg.kg and oral intake at 4 μg.kg ten minutes before the induction of anesthesia. The PK and PD of dexmedetomidine after a single low dose administration and its effect on the surgical field in tympanoplasty were analysed. A plasma concentration of dexmedetomidine of 220 pg/ml was achieved immediately after intravenous infusion and at 13.2 and 70.3 min for intranasal and oral administration, respectively. Dexmedetomidine decreased the heart rate (HR) and mean arterial pressure (MAP) in all three groups, although these values remained higher in the oral dexmedetomidine group at all eight time points. Intravenous dexmedetomidine provided the best visualization of the surgical field for opening of the tympanic sinus, 30 min after the start of the infusion ( < 0.05). Intranasal dexmedetomidine provided a significantly better visual field than oral dexmedetomidine for the repair of a tympanic membrane perforation using the fascia temporal muscle ( < 0.05). A single low dose of dexmedetomidine administered intravenously or intranasally could decrease HR and MAP, improve surgical field visibility and be appropriate for deliberate hypotension for surgical procedures of 1-2 h in length. Clinicaltrials.gov identifier: NCT03800641.
围手术期给予右美托咪定有诸多益处。本研究比较了麻醉前静脉注射、鼻内给药和口服右美托咪定的药代动力学（PK）和药效动力学（PD），并评估了右美托咪定对鼓室成形术手术视野清晰度的影响。在一家大学附属医院进行了一项单盲随机对照试验，45例接受全身麻醉下鼓室成形术的患者被随机分为三组。麻醉诱导前10分钟，右美托咪定通过静脉输注以0.8μg·kg的剂量给药10分钟，鼻内滴注以1μg·kg的滴速给药，口服以4μg·kg的剂量给药。分析了单次低剂量给药后右美托咪定的PK和PD及其对鼓室成形术手术视野的影响。静脉输注后立即达到右美托咪定血浆浓度220pg/ml，鼻内给药和口服给药分别在13.2分钟和70.3分钟达到该浓度。右美托咪定降低了所有三组患者的心率（HR）和平均动脉压（MAP），尽管在所有八个时间点口服右美托咪定组的这些值仍较高。静脉注射右美托咪定在输注开始后30分钟为鼓室窦开口提供了最佳的手术视野可视化效果（P<0.05）。在使用颞肌筋膜修复鼓膜穿孔时，鼻内给予右美托咪定的视野明显优于口服右美托咪定（P<0.05）。静脉或鼻内给予单次低剂量右美托咪定可降低HR和MAP，改善手术视野清晰度，适用于时长为1 - 2小时的手术的控制性低血压。Clinicaltrials.gov标识符：NCT03800641。
