Shankar Kantharaju, Rangalakshmi Srinivasan, Kailash P, Priyanka D
Department of Anesthesia, Rajarajeswari Medical College and Hospital, Kambipura, Karnataka, India.
Asian J Anesthesiol. 2022 Mar 1;60(1):33-40. doi: 10.6859/aja.202203_60(1).0005.
Dexmedetomidine has been used by multiple routes in laparoscopic surgeries to attenuate the hemodynamic response. The present study was done to compare the efficacy of dexmedetomidine nebulization with intravenous dexmedetomidine and fentanyl in laparoscopic surgeries under general anesthesia.
A prospective, double blind study was conducted, and 90 American Society of Anesthesiologists (ASA) I and II patients of either gender between 18-65 years undergoing laparoscopic surgeries under general anesthesia were randomized into three groups. (1) Group N (n = 30) received dexmedetomidine nebulization 1 mcg/kg in 3 mL of 0.9% saline 15 minutes before induction and 10 mL of intravenous 0.9% saline over 10 minutes at the time of induction of anesthesia. (2) Group I (n = 30) received 0.9% saline nebulization 3 mL and intravenous dexmedetomidine 1 mcg/kg in 10 mL of 0.9% saline. (3) Group F (n = 30) received 0.9% saline nebulization 3 mL and intravenous fentanyl 2 mcg/kg in 10mL of 0.9% saline. Heart rate, blood pressure, propofol requirement, and opioid consumption were monitored throughout surgery and for 1 hour in post-operative period. Statistical analysis was done by using analysis of variance test, chi-square test. P value ＜ 0.05 was considered signifi cant.
Suppression of hemodynamic response following intubation and pneumoperitoneum by dexmedetomidine nebulization was compared to intravenous dexmedetomidine and fentanyl. Opioid requirement was significantly lower in dexmedetomidine group than fentanyl group (P ＜ 0.05). Propofol requirement was lower with intravenous and nebulized dexmedetomidine than intravenous fentanyl.
In laparoscopic surgeries, nebulized dexmedetomidine suppresses hemodynamic response when compared to intravenous dexmedetomidine along with dose sparing effect of opioid and propofol.
在腹腔镜手术中，右美托咪定已通过多种途径使用，以减轻血流动力学反应。本研究旨在比较右美托咪定雾化与静脉注射右美托咪定和芬太尼在全身麻醉下腹腔镜手术中的疗效。
进行了一项前瞻性双盲研究，将90例年龄在18至65岁之间、接受全身麻醉下腹腔镜手术的美国麻醉医师协会（ASA）I级和II级患者随机分为三组。（1）N组（n = 30）在诱导前15分钟接受1 mcg/kg右美托咪定雾化于3 mL 0.9%盐水中，麻醉诱导时在10分钟内静脉输注10 mL 0.9%盐水。（2）I组（n = 30）接受3 mL 0.9%盐水雾化和10 mL 0.9%盐水中静脉注射1 mcg/kg右美托咪定。（3）F组（n = 30）接受3 mL 0.9%盐水雾化和10 mL 0.9%盐水中静脉注射2 mcg/kg芬太尼。在整个手术过程和术后1小时监测心率、血压、丙泊酚需求量和阿片类药物消耗量。采用方差分析、卡方检验进行统计学分析。P值＜0.05被认为具有统计学意义。
将右美托咪定雾化与静脉注射右美托咪定和芬太尼对插管和气腹后血流动力学反应的抑制作用进行比较。右美托咪定组的阿片类药物需求量显著低于芬太尼组（P＜0.05）。静脉注射和雾化右美托咪定的丙泊酚需求量低于静脉注射芬太尼。
在腹腔镜手术中，与静脉注射右美托咪定相比，雾化右美托咪定可抑制血流动力学反应，同时具有节省阿片类药物和丙泊酚的作用。
