Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan.
BMC Anesthesiol. 2023 Apr 3;23(1):110. doi: 10.1186/s12871-023-02032-0.
Dexmedetomidine is an alpha-2 agonist with anti-anxiety, sedative, and analgesic effects and causes a lesser degree of respiratory depression. We hypothesized that the use of dexmedetomidine in non-intubated video-assisted thoracic surgery (VATS) may reduce opioid-related complications such as postoperative nausea and vomiting (PONV), dyspnea, constipation, dizziness, skin itching, and cause minimal respiratory depression, and stable hemodynamic status.
Patients who underwent non-intubated VATS lung wedge resection with propofol combined with dexmedetomidine (group D) or alfentanil (group O) between December 2016 and May 2022 were enrolled in this retrospective propensity score matching cohort study. Intraoperative vital signs, arterial blood gas data, perioperative results and treatment outcomes were analyzed. Of 100 patients included in the study (group D, 50 and group O, 50 patients), group D had a significantly lower degree of decrement in the heart rate and the blood pressure than group O. Intraoperative one-lung arterial blood gas revealed lower pH and significant ETCO. The common opioid-related side effects, including PONV, dyspnea, constipation, dizziness, and skin itching, all of which occurred more frequently in group O than in group D. Patients in group O had significantly longer postoperative hospital stay and total hospital stay than group D, which might be due to opioid-related side effects postoperatively.
The application of dexmedetomidine in non-intubated VATS resulted in a significant reduction in perioperative opioid-related complications and maintenance with acceptable hemodynamic performance. These clinical outcomes found in our retrospective study may enhance patient satisfaction and shorten the hospital stay.
右美托咪定是一种 α-2 激动剂，具有抗焦虑、镇静和镇痛作用，且引起的呼吸抑制程度较轻。我们假设，在非插管视频辅助胸腔手术（VATS）中使用右美托咪定可能会减少与阿片类药物相关的并发症，如术后恶心和呕吐（PONV）、呼吸困难、便秘、头晕、皮肤瘙痒，并导致最小程度的呼吸抑制和稳定的血流动力学状态。
本回顾性倾向评分匹配队列研究纳入了 2016 年 12 月至 2022 年 5 月期间接受非插管 VATS 肺楔形切除术的患者，这些患者使用丙泊酚联合右美托咪定（D 组）或阿芬太尼（O 组）进行麻醉。分析术中生命体征、动脉血气数据、围手术期结果和治疗结局。在纳入的 100 例患者（D 组 50 例，O 组 50 例）中，D 组的心率和血压下降程度明显低于 O 组。术中单肺动脉血气显示 pH 值较低，且 ETCO 显著下降。常见的阿片类药物相关副作用，包括 PONV、呼吸困难、便秘、头晕和皮肤瘙痒，在 O 组中比在 D 组中更为常见。O 组患者的术后住院时间和总住院时间明显长于 D 组，这可能是由于术后阿片类药物相关副作用引起的。
右美托咪定在非插管 VATS 中的应用可显著减少围手术期与阿片类药物相关的并发症，并保持可接受的血流动力学性能。这些在我们的回顾性研究中发现的临床结果可能会提高患者满意度并缩短住院时间。
