静脉注射氨茶碱对右美托咪定低血压麻醉下接受功能性内镜鼻窦手术患者血流动力学及恢复情况的影响：一项随机对照研究
Effect of Intravenous Aminophylline on Hemodynamics and Recovery of Patients Undergoing Functional Endoscopic Sinus Surgery Under Dexmedetomidine Hypotensive Anesthesia: A Randomized Controlled Study.
作者信息
Rehab Osama Mohammed, Bakr Doha Mohammed, Algazzar Osama Abdelmoneam, Morsy Islam
机构信息
Anesthesiology, Surgical Intensive Care and Pain Management Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Anesthesiology, Surgical Intensive Care and Pain Management Department, Faculty of Medicine, Helwan University, Helwan, Egypt.
出版信息
Anesth Pain Med. 2023 Dec 29;13(6):e141669. doi: 10.5812/aapm-141669. eCollection 2023 Dec.
BACKGROUND
The sympatholytic property of dexmedetomidine (DEX) makes it suitable as a hypotensive drug during functional endoscopic sinus surgery (FESS); however, delayed emergence from anesthesia and high postoperative sedation have been reported.
OBJECTIVES
Delayed emergence from anesthesia and high postoperative sedation are associated with a prolonged length of stay in the operating room and the postanesthesia care unit (PACU), which increases health care costs. This study aimed to overcome the negative impact of DEX on recovery by using aminophylline.
METHODS
This randomized, double-blind, placebo-controlled study was conducted on 52 patients planned for elective FESS under general anesthesia with DEX infusion for controlled hypotension during surgery. Patients were equally divided into 2 groups. The aminophylline group received 4 mg/kg aminophylline diluted in 50 mL saline 0.9% over 30 minutes after positioning in a 20-degree reverse Trendelenburg position. The control group received 50 mL saline 0.9% with a similar volume and period as the aminophylline group.
RESULTS
The extubation time was significantly shorter in the aminophylline group (6.5 (5.25 - 7.75) minutes) than in the control group (9 (7.25 - 10) minutes) (P-value < 0.001). The PACU discharge time was significantly shorter in the aminophylline group (15 (10 - 20) minutes) compared to the control group (20 (15 - 28.75) minutes) (P-value = 0.036). Intraoperative heart rate and mean arterial pressure were nonsignificantly different between the 2 groups. Ramsay sedation score measurements at 15 min, 30 min, and 60 min after extubation were significantly lower in the aminophylline than in the control group (P-value < 0.05). Complications were nonsignificantly different between the 2 groups.
CONCLUSIONS
Intraoperative aminophylline infusion enhances the recovery of patients undergoing FESS under DEX hypotensive anesthesia without intraoperative hemodynamic alterations and decreases their postoperative sedation without significant postoperative side effects.
背景
右美托咪定（DEX）的交感神经阻滞特性使其适合作为功能性鼻内镜鼻窦手术（FESS）期间的降压药物；然而，有报道称其会导致麻醉苏醒延迟和术后高镇静状态。
目的
麻醉苏醒延迟和术后高镇静状态与手术室和麻醉后监护病房（PACU）的住院时间延长有关，这会增加医疗成本。本研究旨在通过使用氨茶碱来克服DEX对恢复的负面影响。
方法
本随机、双盲、安慰剂对照研究纳入了52例计划在全身麻醉下接受择期FESS的患者，术中输注DEX以控制低血压。患者被平均分为2组。氨茶碱组在置于20度反向头低脚高位后30分钟内，接受将4 mg/kg氨茶碱稀释于50 mL 0.9%生理盐水中的溶液。对照组接受50 mL 0.9%生理盐水，输注体积和时间与氨茶碱组相似。
结果
氨茶碱组的拔管时间（6.5（5.25 - 7.75）分钟）显著短于对照组（9（7.25 - 10）分钟）（P值<0.001）。氨茶碱组的PACU出院时间（15（10 - 20）分钟）明显短于对照组（20（15 - 28.75）分钟）（P值 = 0.036）。两组术中心率和平均动脉压无显著差异。拔管后15分钟、30分钟和60分钟时氨茶碱组的Ramsay镇静评分显著低于对照组（P值<0.05）。两组并发症无显著差异。
结论
术中输注氨茶碱可促进在DEX降压麻醉下接受FESS的患者恢复，且术中血流动力学无改变，并可降低其术后镇静程度，且无明显术后副作用。
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