Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine (Sunderbyn), Umeå University, Umeå, Sweden.
Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden.
J Perianesth Nurs. 2023 Jun;38(3):454-460. doi: 10.1016/j.jopan.2022.08.009. Epub 2023 Jan 4.
Sedative premedication in children may negatively impact their cardiorespiratory status during the perioperative course, and no clear consensus exists on the optimal premedication treatment for pediatric patients. The objective was to compare the perioperative cardiorespiratory responses to sedation using three different sedative premedication regimens in preschool children scheduled for surgery with total intravenous anesthesia.
A single-center randomized controlled trial.
This is a planned secondary analysis of a study conducted at a 200-bed tertiary referral hospital. Ninety children participated in the study. They were aged 2-6 years and scheduled for ear, nose, and throat surgery with propofol/remifentanil anesthesia. Participants were randomly assigned to receive oral midazolam 0.5 mg/kg (MID), oral clonidine 4 mcg/kg (CLO), or intranasal dexmedetomidine 2 mcg/kg (DEX). The main outcome measures were the sedation level, based on the Ramsay Sedation Scale (RSS), and cardiorespiratory status, monitored during the perioperative period.
The final cohort had 83 children (MID, n=27; CLO, n=26; DEX, n=30), with similar intergroup patient characteristics. RSS scores were lower in the MID group than in the CLO and DEX groups before induction and within 30 min postsurgery (P<0.001 and P=0.006, respectively). A negative correlation existed between the RSS and heart rate (HR) (r=-0.570, P<0.001). Before anesthesia induction, the respiratory rate was lowest in the DEX group (MID 21.5±1.7 min, CLO 20.6±2.6 min, DEX 20.2±1.7 min; P=0.042). The HR was lower in the CLO and DEX groups than in the MID group (MID, 102.8±10.0 min; CLO, 87.4±9.6 min; DEX, 87.6±7.9 min; P<0.001). The HR was lower immediately after induction (P=0.009) and intraoperatively (P=0.025) in the CLO and DEX groups than in the MID group.
When used as premedication before propofol/remifentanil anesthesia, clonidine and dexmedetomidine provided deeper preoperative sedation compared to midazolam. From a clinical perspective, all three study drugs provided essentially stable cardiovascular and respiratory conditions during the entire perioperative period.
在围手术期，儿童镇静预处理可能会对其心肺状态产生负面影响，但对于儿科患者的最佳预处理治疗方法尚无明确共识。本研究旨在比较三种不同镇静预处理方案在接受全凭静脉麻醉的学龄前儿童手术中的围术期心肺反应。
单中心随机对照试验。
这是在一家 200 张床位的三级转诊医院进行的一项研究的计划二次分析。90 名儿童参与了这项研究。他们年龄在 2-6 岁之间，计划接受耳鼻喉手术，使用丙泊酚/瑞芬太尼麻醉。参与者被随机分配接受口服咪达唑仑 0.5mg/kg（MID）、口服可乐定 4 mcg/kg（CLO）或鼻内右美托咪定 2 mcg/kg（DEX）。主要观察指标是基于 Ramsay 镇静评分（RSS）的镇静水平和围手术期监测的心肺状态。
最终队列包括 83 名儿童（MID 组 27 名，CLO 组 26 名，DEX 组 30 名），各组间患者特征相似。与 CLO 和 DEX 组相比，MID 组在诱导前和术后 30 分钟内的 RSS 评分较低（P<0.001 和 P=0.006）。RSS 与心率（HR）呈负相关（r=-0.570，P<0.001）。麻醉诱导前，DEX 组呼吸频率最低（MID 组 21.5±1.7 min，CLO 组 20.6±2.6 min，DEX 组 20.2±1.7 min；P=0.042）。CLO 和 DEX 组的 HR 低于 MID 组（MID 组 102.8±10.0 min；CLO 组 87.4±9.6 min；DEX 组 87.6±7.9 min；P<0.001）。诱导后即刻（P=0.009）和手术期间（P=0.025）CLO 和 DEX 组的 HR 均低于 MID 组。
在丙泊酚/瑞芬太尼麻醉前用作预处理时，可乐定和右美托咪定与咪达唑仑相比提供了更深的术前镇静作用。从临床角度来看，三种研究药物在整个围手术期均提供了基本稳定的心血管和呼吸状况。
