Sharma Neha, Pandey Maitree, Gupta Anshu, Kumar Anil
Anaesthesia and Critical Care, Lady Hardinge Medical College, New Delhi, IND.
Anaesthesiology, Lady Hardinge Medical College, New Delhi, IND.
Cureus. 2022 Mar 19;14(3):e23309. doi: 10.7759/cureus.23309. eCollection 2022 Mar.
Minor gynaecological procedures are usually done in outpatient settings. Early discharge with minimal haemodynamic compromise is an essential requirement of these procedures. Many sedative drugs are being used for outpatient surgeries. Of the sedative agents available, dexmedetomidine, which has sedative and analgesic sparing effects, has the best safety profile in the cardiorespiratory system. Therefore, we evaluated the optimum dexmedetomidine dose for providing better procedural sedation.
This randomized, double-blinded study included 120 ASA grade I and II patients aged 18-45 years who were undergoing short gynaecological procedures in a tertiary care hospital. Patients were randomly allocated into three groups of 40 each. After a loading dose of 1 µg/kg over 10 min, group A received dexmedetomidine infusion at a rate of 0.2 µg/kg/hr, group B at a rate of 0.4 µg/kg/hr, and group C at a rate of 0.6 µg/kg/hr. Perioperative hemodynamic changes, intraoperative adjuvant drug requirements, and postoperative recovery were also compared in the three different dexmedetomidine groups.
Heart rate, blood pressure, oxygen saturation, and respiratory rate remained within the normal physiological range in all three groups at most perioperative time points. The time to achieve the Modified Aldrete Score and the post-anesthetic discharge scoring system was maximum in group C and minimum in group A. Ketamine had to be supplemented in almost half of the patients in group A and less than a quarter of the patients in group B. In group C, surgery was completed without any drug supplementation. Two patients in group B and four patients in group C had an episode of bradycardia. Oxygen saturation decreased in one patient in group C, necessitating oxygen supplementation.
Dexmedetomidine, at a dose of 0.4 µg/kg/hr with ketamine supplementation, provides the most appropriate procedural sedation and analgesia (PSA) without any significant hemodynamic compromise.
小型妇科手术通常在门诊进行。早期出院且血流动力学影响最小是这些手术的基本要求。许多镇静药物被用于门诊手术。在可用的镇静剂中，具有镇静和镇痛作用且对心血管呼吸系统安全性最佳的右美托咪定。因此，我们评估了能提供更好手术镇静效果的右美托咪定最佳剂量。
这项随机、双盲研究纳入了120名年龄在18至45岁、美国麻醉医师协会（ASA）分级为I级和II级、在三级医院接受简短妇科手术的患者。患者被随机分为三组，每组40人。在10分钟内给予1μg/kg的负荷剂量后，A组以0.2μg/kg/小时的速率输注右美托咪定，B组以0.4μg/kg/小时的速率输注，C组以0.6μg/kg/小时的速率输注。还比较了三个不同右美托咪定组的围手术期血流动力学变化、术中辅助药物需求和术后恢复情况。
在大多数围手术期时间点，三组患者的心率、血压、血氧饱和度和呼吸频率均保持在正常生理范围内。达到改良Aldrete评分和麻醉后出院评分系统的时间在C组最长，在A组最短。A组几乎一半的患者需要补充氯胺酮，B组不到四分之一的患者需要补充。在C组，手术在未补充任何药物的情况下完成。B组有2名患者和C组有4名患者出现心动过缓。C组有1名患者血氧饱和度下降，需要吸氧。
以0.4μg/kg/小时的剂量输注右美托咪定并补充氯胺酮，可提供最合适的手术镇静和镇痛（PSA），且不会造成任何显著的血流动力学影响。
