Monaco Fabrizio, Barucco Gaia, Lerose Caterina C, DE Luca Monica, Licheri Margherita, Mucchetti Marta, Labanca Rosa, Morselli Federica, Mattioli Cristina, Russetti Federica, Zangrillo Alberto
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Institute, Milan, Italy -
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Institute, Milan, Italy.
Minerva Anestesiol. 2023 Apr;89(4):256-264. doi: 10.23736/S0375-9393.22.16782-9. Epub 2023 Jan 18.
Sedation protocols in patients undergoing complex endovascular aortic aneurysm repair are not fully investigated. The aim of this study was to compare a dexmedetomidine (DEX) based sedation protocol with a remifentanil-based sedation protocol.
Seventy-nine consecutive patients undergoing complex endovascular aortic repair were enrolled and retrospectively analyzed. Forty-two received 0.03 mg/kg midazolam intravenous bolus with remifentanil (0.075-0.1 μg/kg/min for 10 minutes followed by continuous infusion 0.050-0.25 μg/kg/min) and 37 DEX (1 μg/kg over 10 minutes and continuous infusion 0.50-0.75 μg/kg/hour) to achieve an Observer Assessment of Alertness/Sedation Scale (OAAS) ≤4, a Richmond Agitation/Sedation Scale (RASS) ≤-2 and a Visual Analogic Scale (VAS) <4. The primary endpoint was patients' satisfaction. Secondary endpoints included assessment of sedation and pain, the incidence of perioperative hemodynamic or gas exchange imbalance, and 36 month-mortality.
Remifentanil group showed a higher satisfaction rate than DEX (P<0.001). Patients on DEX were more sedated than remifentanil according to OAAS (3 [2-3] vs. 4 [3-4]; P=0.001) and RASS (-2[-3/-2] vs. -2[-2/-2]; P=0.001) with no difference in VAS (2 [1-3] vs. 2 [1-3]; P=0.41). DEX provides reliable sedation with lower patient's satisfaction. A higher number of patients were discharged from the recovery room on vasopressors in the DEX group compare with the remifentanil group (5 vs. 0; P=0.045, respectively). The two groups showed a non-significant difference in the survival rate at 36-month (DEX 67% vs. remifentanil 73%; (P=0.90).
In this setting remifentanil provides reliable sedation with higher patient's satisfaction and less hemodynamic effect than DEX.
对于接受复杂血管内主动脉瘤修复术的患者，镇静方案尚未得到充分研究。本研究的目的是比较基于右美托咪定（DEX）的镇静方案和基于瑞芬太尼的镇静方案。
纳入79例连续接受复杂血管内主动脉修复术的患者并进行回顾性分析。42例患者静脉推注0.03mg/kg咪达唑仑并给予瑞芬太尼（先以0.075 - 0.1μg/kg/min输注10分钟，随后以0.050 - 0.25μg/kg/min持续输注），37例患者给予DEX（1μg/kg静脉输注10分钟，随后以0.50 - 0.75μg/kg/小时持续输注），以使观察者警觉/镇静评分量表（OAAS）≤4、里士满躁动/镇静评分量表（RASS）≤ -2以及视觉模拟评分量表（VAS）<4。主要终点是患者满意度。次要终点包括镇静和疼痛评估、围手术期血流动力学或气体交换失衡的发生率以及36个月死亡率。
瑞芬太尼组的满意度高于DEX组（P<0.001）。根据OAAS（3[2 - 3]对4[3 - 4]；P = 0.001）和RASS（-2[-3/-2]对-2[-2/-2]；P = 0.001），DEX组患者比瑞芬太尼组患者镇静程度更深，而VAS无差异（2[1 - 3]对2[1 - 3]；P = 0.41）。DEX能提供可靠的镇静，但患者满意度较低。与瑞芬太尼组相比，DEX组有更多患者在使用血管升压药的情况下从恢复室出院（分别为5例对0例；P = 0.045）。两组在36个月时的生存率无显著差异（DEX组为67%，瑞芬太尼组为73%；P = 0.90）。
在此情况下，与DEX相比，瑞芬太尼能提供可靠的镇静，患者满意度更高，血流动力学影响更小。
