评价右美托咪定和咪达唑仑-氯胺酮术前用药在斜视手术中的围手术期效果。

Evaluation of the Perioperative Effects of Dexmedetomidine and Midazolam-Ketamine Premedication in Strabismus Surgery.

出版信息

J Pediatr Ophthalmol Strabismus. 2023 Nov-Dec;60(6):427-434. doi: 10.3928/01913913-20221219-01. Epub 2023 Feb 21.

DOI:10.3928/01913913-20221219-01

Abstract

PURPOSE

To evaluate the effects of intranasal dexmedetomidine and midazolam-ketamine combination for premedication on sedation quality, oculocardiac reflex development, mask tolerance, and separation from parents in children who would undergo strabismus surgery.

METHODS

A total of 74 patients aged 2 to 11 years, were divided into two groups. The dexmedetomidine group (n = 37) received 1 mcg/kg of dexmedetomidine and the midalozam-ketamine group (n = 37) received 0.1 mg/kg of midazolam and 7.5 mg/kg of ketamine combination intranasally. Mean arterial pressure, peripheral oxygen saturation, Ramsay Sedation Scale values, and heart rate were recorded before and after the premedication. The children's separation from the family scores were evaluated and recorded. The mask compliance was evaluated and recorded. Patients who developed oculocardiac reflex and were administered atropine were recorded. In the postoperative period, nausea and vomiting, recovery times, and postoperative agitation were evaluated.

RESULTS

Ramsay Sedation Scale scores, mask acceptance, and family separation scores were similar in both groups ( > .05). Oculocardiac reflex was observed more in the dexmedetomidine group ( = .048). Atro-pine requirement and postoperative nausea and vomiting rates were similar in both groups ( > .05). Mean arterial pressures and heart rates were significantly lower in the dexmedetomidine group during the pre-medication period. The recovery time was longer in the midazolam-ketamine group ( < .001). The incidence of postoperative agitation was significantly lower in the midazolam-ketamine group ( = .001).

CONCLUSIONS

The sedation efficacy of intranasal dexmedetomidine and midazolam-ketamine combination that were given in premedication was similar. Oculocardiac reflex was observed more with dexmedetomidine. The recovery time was prolonged in the midazolam-ketamine group, but postoperative agitation was observed less. .

摘要

目的

评估鼻内给予右美托咪定和咪达唑仑-氯胺酮联合用药作为斜视手术患儿术前用药对镇静质量、眼心反射发展、面罩耐受和与父母分离的影响。

方法

将 74 名 2 至 11 岁的患者分为两组。右美托咪定组（n=37）给予 1 mcg/kg 右美托咪定，咪达唑仑-氯胺酮组（n=37）给予 0.1 mg/kg 咪达唑仑和 7.5 mg/kg 氯胺酮联合经鼻给药。记录用药前和用药后的平均动脉压、外周血氧饱和度、Ramsay 镇静评分和心率。评估并记录患儿与家人分离的评分。评估并记录面罩顺应性。记录发生眼心反射并给予阿托品的患者。在术后期间，评估恶心和呕吐、恢复时间和术后激越的发生情况。

结果

两组的 Ramsay 镇静评分、面罩接受度和家庭分离评分相似（>0.05）。右美托咪定组更易发生眼心反射（=0.048）。两组阿托品需求和术后恶心呕吐发生率相似（>0.05）。在用药期间，右美托咪定组的平均动脉压和心率明显更低。咪达唑仑-氯胺酮组的恢复时间更长（<0.001）。咪达唑仑-氯胺酮组的术后激越发生率明显更低（=0.001）。