Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Universitas Airlangga, Jl. Mayjen Prof. Dr. Moestopo No. 6-8, Airlangga, Gubeng, Surabaya, 60286, Indonesia.
Department of Plastic and Reconstructive Surgery, Rumah Sakit Umum Pusat Persahabatan, Jl. Persahabatan Raya No. 1, Jakarta Timur, 13230, Indonesia.
J Med Case Rep. 2024 Jul 16;18(1):342. doi: 10.1186/s13256-024-04645-6.
Surgery for pediatric cleft lip and palate repair often utilizes high-dose opioids and inhaled anesthesia, thereby causing postoperative complications such as desaturation and/or severe agitation after anesthesia. These complications are detrimental to the child and medical personnel and cause tremendous psychologic stress to parents. Our aim is to decrease these complications through dexmedetomidine, an alpha-2 receptor agonist with anxiolytic, sympatholytic, and analgetic properties. Devoid of respiratory depressant effect, it allows patients to maintain effective ventilation and reduce agitation, postoperatively. Its unique anesthetic property may shed light on providing safe anesthesia and gentle emergence to this young, vulnerable population.
A total of 21 patients of Sundanese ethnicity, aged 3 months to 8 years (9 males and 12 females), underwent cleft lip or cleft palate surgery using total intravenous dexmedetomidine. Anesthesia was induced using sevoflurane, fentanyl, and propofol, and airway was secured. Intravenous dexmedetomidine 1.5 μg/kg was administered within 10 minutes, and a maintenance dose of 1.5 μg/kg/hour was continued as the sole anesthetic maintenance agent thereafter. Hemodynamics and anesthetic depth using Patient State Index (SEDLine™ monitor, Masimo Corporation, Irvine, CA, USA) were monitored carefully throughout the surgical procedure. Dexmedetomidine did not cause any hemodynamic derangements or postoperative complications in any of our patients. We found agitation in 9.5% (2/21) of patients.
Dexmedetomidine can be used as a total intravenous anesthetic agent to maintain anesthesia and provide gentle emergence to infants and young children undergoing cleft lip and palate repair.
小儿唇腭裂修复手术常采用大剂量阿片类药物和吸入性麻醉，由此导致麻醉后出现低氧血症和/或严重激越等术后并发症。这些并发症对患儿和医务人员不利，并给患儿家长造成巨大心理压力。我们旨在通过使用具有镇静、交感神经抑制和镇痛作用的 α-2 受体激动剂右美托咪定来减少这些并发症。它没有呼吸抑制作用，可使患者在术后保持有效通气并减少激越。其独特的麻醉特性可能为这一年幼、脆弱的人群提供安全的麻醉和温和的苏醒提供启示。
共 21 例 3 个月至 8 岁（9 名男性和 12 名女性）苏旦族患儿接受全凭静脉右美托咪定行唇裂或腭裂手术。使用七氟醚、芬太尼和丙泊酚诱导麻醉，并确保气道通畅。在 10 分钟内给予 1.5μg/kg 静脉右美托咪定，此后作为唯一的麻醉维持剂持续给予 1.5μg/kg/h 维持剂量。在整个手术过程中，仔细监测患者状态指数（SEDLine™监测仪，Masimo 公司，加利福尼亚州欧文市）的血流动力学和麻醉深度。右美托咪定在我们的任何患者中均未引起任何血流动力学紊乱或术后并发症。我们发现 9.5%（2/21）的患者有激越。
右美托咪定可作为全凭静脉麻醉药物，用于维持麻醉，并为行唇腭裂修复术的婴儿和幼儿提供温和苏醒。
