Shetabi Hamidreza, Akrami Moghaddam Faride, Kazemi Reza
Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences Isfahan, Iran.
School of Medicine, Isfahan University of Medical Sciences Isfahan, Iran.
Am J Clin Exp Urol. 2023 Apr 15;11(2):160-167. eCollection 2023.
According to the favorable effects of combination therapy to provide better sedation during double-j stent removal and lack of studies investigating the sedative effect of propofol, dexmedetomidine, and midazolam during this procedure. This study aimed to compare the effects of intravenous sedation with propofol, dexmedetomidine and midazolam in double-J ureteral stent removal.
This double-blinded randomized clinical trial was conducted on 120 patients aged 18-72 who underwent double-J ureteral stent removal in Alzahra hospital, Isfahan, Iran from September to November 2021. Patients were randomly divided into 3 groups. In the first group, propofol was titrated with normal saline and was infused with a loading dose of 0.5 mg/kg and a maintenance dose of 1.5-2.5 mg/kg/h. In the second group, Dexmedetomidine was titrated with normal saline and was infused at a dose of 1 µg/kg within 10 min and then continued at 0.45-0.55 µg/kg. In third group, midazolam was titrated was infused with a loading dose of 0.05 mg/kg and a maintenance dose of 0.05 mg/kg/h. 50 mg of fentanyl was also infused in all the groups. If the patients did not reach the desired sedation level, 10 mg ketamine was infused as a rescue sedative agent for all three groups and repeated if needed in all groups.
The current study was conducted on 120 patients who underwent double-J ureteral stent removal. The comparison of the sedative effect of midazolam, dexmedetomidine, and propofol showed significant differences among the three groups and was higher in the midazolam group (P=0.018). Between the three groups systolic blood pressure and mean arterial pressure was significantly lower in the propofol group (P=0.002). Heart rate was significantly lower in the dexmedetomidine group during both surgery and recovery time (P<0.001). There was no significant difference among the groups during surgery regarding oxygen saturation ( value =0.84). The intergroup comparison indicates that the mean score of surgeon satisfaction is significantly higher in the midazolam group (-value =0.039).
According to this study midazolam was superior to two other groups and was associated with deeper sedation and higher satisfaction among both patient and surgeon.
联合治疗在双J支架取出术中能提供更好的镇静效果，但目前缺乏关于丙泊酚、右美托咪定和咪达唑仑在此手术过程中镇静效果的研究。本研究旨在比较静脉注射丙泊酚、右美托咪定和咪达唑仑在双J输尿管支架取出术中的镇静效果。
本双盲随机临床试验于2021年9月至11月在伊朗伊斯法罕的阿尔扎赫拉医院对120例年龄在18 - 72岁之间接受双J输尿管支架取出术的患者进行。患者被随机分为3组。第一组，丙泊酚用生理盐水滴定，以0.5mg/kg的负荷剂量和1.5 - 2.5mg/kg/h的维持剂量输注。第二组，右美托咪定用生理盐水滴定，在10分钟内以1μg/kg的剂量输注，然后以0.45 - 0.55μg/kg的剂量持续输注。第三组，咪达唑仑用生理盐水滴定，以0.05mg/kg的负荷剂量和0.05mg/kg/h的维持剂量输注。所有组均输注50mg芬太尼。如果患者未达到所需的镇静水平，所有三组均输注10mg氯胺酮作为抢救镇静剂，必要时可重复使用。
本研究对120例接受双J输尿管支架取出术的患者进行。咪达唑仑、右美托咪定和丙泊酚镇静效果的比较显示三组之间存在显著差异，咪达唑仑组更高（P = 0.018）。三组之间，丙泊酚组的收缩压和平均动脉压显著更低（P = 0.002）。右美托咪定组在手术和恢复期间的心率显著更低（P < 0.001）。手术期间各小组之间的血氧饱和度无显著差异（值 = 0.84）。组间比较表明，咪达唑仑组外科医生满意度的平均得分显著更高（-值 = 0.039）。
根据本研究，咪达唑仑优于其他两组，与更深的镇静以及患者和外科医生更高的满意度相关。
