Section on Cardiovascular Medicine, Department of Internal Medicine Wake Forest School of Medicine Winston-Salem NC.
Department of Anesthesiology Wake Forest School of Medicine Winston-Salem NC.
J Am Heart Assoc. 2022 Oct 4;11(19):e026198. doi: 10.1161/JAHA.122.026198. Epub 2022 Sep 21.
Background Methohexital and propofol can both be used as sedation for direct current cardioversion (DCCV). However, there are limited data comparing these medications in this setting. We hypothesized that patients receiving methohexital for elective DCCV would be sedated more quickly, recover from sedation faster, and experience less adverse effects. Methods and Results This was a prospective, blinded randomized controlled trial conducted at a single academic medical center. Eligible participants were randomly assigned to receive either methohexital (0.5 mg/kg) or propofol (0.8 mg/kg) as a bolus for elective DCCV. The times from bolus of the medication to achieving a Ramsay Sedation Scale score of 5 to 6, first shock, eyes opening on command, and when the patient could state their age and name were obtained. The need for additional medication dosing, airway intervention, vital signs, and medication side effects were also recorded. Seventy patients who were randomized to receive methohexital (n=37) or propofol (n=33) were included for analysis. The average doses of methohexital and propofol were 0.51 mg/kg and 0.84 mg/kg, respectively. There were no significant differences between methohexital and propofol in the time from end of injection to loss of conscious (1.4±1.8 versus 1.1±0.5 minutes; =0.33) or the time to first shock (1.7±1.9 versus 1.4±0.5 minutes; =0.31). Time intervals were significantly lower for methohexital compared with propofol in the time to eyes opening on command (5.1±2.5 versus 7.8±3.7 minutes; =0.0005) as well as at the time to the ability to answer simple questions of age and name (6.0±2.6 versus 8.6±4.0 minutes; =0.001). The methohexital group experienced less hypotension (8.1% versus 42.4%; <0.001) and less hypoxemia (0.0% versus 15.2%; =0.005), had lower need for jaw thrust/chin lift (16.2% versus 42.4%; =0.015), and had less pain on injection compared with propofol using the visual analog scale (7.2±9.7 versus 22.4±28.1; =0.003). Conclusions In this model of fixed bolus dosing, methohexital was associated with faster recovery, more stable hemodynamics, and less hypoxemia after elective DCCV compared with propofol. It can be considered as a preferred agent for sedation for DCCV. Registration URL: https://www.clinicaltrials.gov/ct; Unique identifier: NCT04187196.
背景
依托咪酯和丙泊酚均可用于直流电复律（DCCV）的镇静。然而，在这种情况下，比较这两种药物的资料有限。我们假设，接受依托咪酯进行选择性 DCCV 的患者镇静更快，从镇静中恢复更快，并且不良反应更少。
方法和结果
这是在一家学术医疗中心进行的前瞻性、盲法随机对照试验。合格的参与者被随机分配接受依托咪酯（0.5mg/kg）或丙泊酚（0.8mg/kg）作为选择性 DCCV 的推注。从推注药物到达到 Ramsay 镇静评分 5-6 分、首次电击、命令睁眼和患者能够说出年龄和姓名的时间。还记录了对额外药物剂量、气道干预、生命体征和药物副作用的需求。
七十名随机接受依托咪酯（n=37）或丙泊酚（n=33）的患者被纳入分析。依托咪酯和丙泊酚的平均剂量分别为 0.51mg/kg 和 0.84mg/kg。依托咪酯和丙泊酚在从注射结束到意识丧失的时间（1.4±1.8 与 1.1±0.5 分钟；=0.33）或首次电击的时间（1.7±1.9 与 1.4±0.5 分钟；=0.31）之间无显著差异。与丙泊酚相比，依托咪酯的睁眼时间（5.1±2.5 与 7.8±3.7 分钟；=0.0005）以及回答年龄和姓名简单问题的时间（6.0±2.6 与 8.6±4.0 分钟；=0.001）均明显更低。依托咪酯组低血压发生率（8.1%与 42.4%；<0.001）和低氧血症发生率（0.0%与 15.2%；=0.005）较低，需要进行下颌推/颏提升的次数（16.2%与 42.4%；=0.015）较少，与丙泊酚相比，依托咪酯注射时疼痛较轻（7.2±9.7 与 22.4±28.1；=0.003）。
结论
在这种固定推注剂量的模型中，与丙泊酚相比，依托咪酯在选择性 DCCV 后恢复更快，血流动力学更稳定，低氧血症发生率更低。它可以被认为是 DCCV 镇静的首选药物。
