Zeng Sisi, Li Xuechao, Xu Hongchun, Ye Qin, Li Zhaogang, Wang Fangjun
Department of Anesthesiology, Xinqiao Hospital, Chongqing, China.
Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Front Med (Lausanne). 2024 Jul 24;11:1426512. doi: 10.3389/fmed.2024.1426512. eCollection 2024.
This study aimed to explore the optimal dose of dexmedetomidine as a 0.59% ropivacaine adjuvant for epidural anesthesia on perioperative hemodynamics and anesthesia efficacy in patients undergoing great saphenous varicose vein surgery.
A total of 90 patients were randomly divided into three groups: 0.25 μg/kg dexmedetomidine combined with 0.59% ropivacaine epidural infusion group (ED group), 0.5 μg/kg dexmedetomidine combined with 0.59% ropivacaine epidural infusion group (ED group), and 0.75 μg/kg dexmedetomidine combined with 0.59% ropivacaine epidural infusion group (ED group). Hemodynamics, anesthesia efficiency, and adverse reactions were recorded.
Compared with the ED group, the ED group had lower systolic blood pressure at T (T, 95%CIs, 6.52-21.93, < 0.001; T, 95%CIs, 2.88-18.21, = 0.004; T, 95%CIs, 0.49-18.17, = 0.035), and the diastolic blood pressure at T was decreased (T, 95%CIs, 4.55-14.36, < 0.001; T, 95%CIs, 0.37-12.17, = 0.033). Compared with the ED group, the ED group had higher systolic blood pressure at T (T, 95%CIs, 5.90-21.46, < 0.001; T, 95%CIs, 2.07-17.55, = 0.008) and higher diastolic blood pressure at T (T, 95%CIs, 2.91-12.81, = 0.001; T, 95%CIs, 1.32-13.23, = 0.011; T, 95%CIs, 0.14-11.52, = 0.043). Compared with the ED group, the heart rate was significantly decreased at T in the ED group (T, 95%CIs, 2.25-15.72, = 0.005; T, 95%CIs, 2.35-13.82, = 0.003; T, 95%CIs, 0.50-9.79, = 0.025; T, 95%CIs, 1.46-10.36, = 0.005). The myocardial oxygen consumption in all three groups was significantly decreased at each time point compared to T ( < 0.05 or < 0.001), and no significant between-group differences were detected (>0.05). Compared with the ED group, the anesthesia efficiency of ED and ED groups was markedly enhanced, but the risk of bradycardia in ED and ED groups was dramatically increased (6 of 28 [21.4%] vs. 14 of 30 [46.7%] and 14 of 27 [51.9%], = 0.023), one patient in the ED group experienced difficulty urinating, and remaining adverse reactions were mild in all three groups.
A measure of 0.5 μg/kg dexmedetomidine is the optimal dose as a 0.59% ropivacaine adjuvant for epidural anesthesia in patients undergoing great saphenous varicose vein surgery.
http://www.chictr.org.cn/, registration number: ChiCTR2200060619.
本研究旨在探讨右美托咪定作为0.59%罗哌卡因辅助剂用于大隐静脉曲张手术患者硬膜外麻醉时的最佳剂量，及其对围手术期血流动力学和麻醉效果的影响。
将90例患者随机分为三组：0.25μg/kg右美托咪定联合0.59%罗哌卡因硬膜外输注组（ED组）、0.5μg/kg右美托咪定联合0.59%罗哌卡因硬膜外输注组（ED组）和0.75μg/kg右美托咪定联合0.59%罗哌卡因硬膜外输注组（ED组）。记录血流动力学、麻醉效果及不良反应。
与ED组相比，ED组在T时收缩压较低（T，95%可信区间，6.52 - 21.93，<0.001；T，95%可信区间，2.88 - 18.21，=0.004；T，95%可信区间，0.49 - 18.17，=0.035），T时舒张压降低（T，95%可信区间，4.55 - 14.36，<0.001；T，95%可信区间，0.37 - 12.17，=0.033）。与ED组相比，ED组在T时收缩压较高（T，95%可信区间，5.90 - 21.46，<0.001；T，95%可信区间，2.07 - 17.55，=0.008），T时舒张压较高（T，95%可信区间，2.91 - 12.81，=0.001；T，95%可信区间，1.32 - 13.23，=0.011；T，95%可信区间，0.14 - 11.52，=0.043）。与ED组相比，ED组在T时心率显著降低（T，95%可信区间，2.25 - 15.72，=0.005；T，95%可信区间，2.35 - 13.82，=0.003；T，95%可信区间，0.50 - 9.79，=0.025；T，95%可信区间，1.46 - 10.36，=0.005）。与T相比，三组在各时间点的心肌耗氧量均显著降低（<0.05或<0.001），组间差异无统计学意义（>0.05）。与ED组相比，ED组和ED组的麻醉效果明显增强，但ED组和ED组的心动过缓风险显著增加（28例中有6例[21.4%] vs. 30例中有14例[46.7%]和27例中有14例[51.9%]，=0.023），ED组有1例患者出现排尿困难，三组其余不良反应均较轻。
0.5μg/kg右美托咪定是大隐静脉曲张手术患者硬膜外麻醉时作为0.59%罗哌卡因辅助剂的最佳剂量。
