右美托咪定在儿童牙科手术全静脉麻醉中减少麻醉药物用量的效果：一项随机对照试验。

Anesthetic-sparing effect of dexmedetomidine during total intravenous anesthesia for children undergoing dental surgery: A randomized controlled trial.

机构信息

Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada.

Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada.

出版信息

Paediatr Anaesth. 2024 Dec;34(12):1213-1222. doi: 10.1111/pan.14987. Epub 2024 Aug 28.

DOI:10.1111/pan.14987

PMID:39193655

Abstract

BACKGROUND

Dexmedetomidine, an α-adrenergic agonist, reduces propofol and remifentanil requirements when used as an adjunct to total intravenous anesthesia in adults, but studies in a pediatric population are sparse. This study investigates the magnitude of dose-sparing effects of a postinduction dexmedetomidine bolus on propofol and remifentanil requirements during pediatric surgery.

METHODS

In this randomized, double-blind, controlled trial, children aged 2-10 years undergoing elective dental surgery were assigned to one of four groups: placebo, 0.25 mcg/kg dexmedetomidine, 0.5 mcg/kg dexmedetomidine, and 1 mcg/kg dexmedetomidine. Maintenance with fixed-ratio propofol and remifentanil total intravenous anesthesia followed a bispectral index (BIS)-guided algorithm designed to maintain a stable depth of anesthesia. The primary outcomes were time-averaged maintenance infusion rates of propofol and remifentanil. Secondary outcomes in the postanesthetic care unit included sedation scores, pain scores, and time to discharge.

RESULTS

Data from 67 patients were available for analysis. The median [interquartile range] propofol infusion rate was lower in the 1 mcg/kg dexmedetomidine group (180 [164-185] mcg/kg/min) versus placebo (200 [178-220] mcg/kg/min): percent change -10.0%; 95% CI -2.4 to -19.8; p = 0.013. The remifentanil infusion rate was also lower in the 1 mcg/kg dexmedetomidine group (0.089 [0.080, 0.095] mcg/kg/min) versus placebo (0.103 [0.095, 0.106] mcg/kg/min): percent change, -13.7%; 95% CI -5.47 to -21.0; p = .022. However, neither propofol nor remifentanil infusion rates were significantly different in the 0.25 or 0.5 mcg/kg dexmedetomidine groups. In the postanesthesia care unit, there were no differences in pain or sedation scores, and time to discharge was not significantly prolonged in any dexmedetomidine group.

CONCLUSION

Dexmedetomidine 1 mcg/kg reduced the propofol and remifentanil requirements during maintenance of anesthesia in children when administered as a postinduction bolus.

TRIALS REGISTRATION

ClinicalTrials.gov: NCT03422978, date of registration 2018-02-06.

摘要

背景

右美托咪定是一种 α-肾上腺素能激动剂，在成人全静脉麻醉中作为辅助药物使用时可减少丙泊酚和瑞芬太尼的需求，但在儿科人群中的研究较少。本研究旨在探讨诱导后给予右美托咪定负荷剂量对小儿手术中丙泊酚和瑞芬太尼需求的剂量节约效应的程度。

方法

这是一项随机、双盲、对照临床试验，纳入 2-10 岁择期行牙科手术的儿童，分为四组：安慰剂组、0.25μg/kg 右美托咪定组、0.5μg/kg 右美托咪定组和 1μg/kg 右美托咪定组。采用基于脑电双频指数（BIS）指导的算法进行丙泊酚和瑞芬太尼全静脉麻醉的维持，以维持稳定的麻醉深度。主要结局为丙泊酚和瑞芬太尼的平均维持输注率。麻醉后恢复室的次要结局包括镇静评分、疼痛评分和出院时间。

结果

67 例患者的数据可用于分析。与安慰剂组（200[178-220]μg/kg/min）相比，1μg/kg 右美托咪定组的丙泊酚输注率中位数[四分位间距]较低（180[164-185]μg/kg/min）：变化百分比-10.0%；95%置信区间-2.4 至-19.8；p=0.013。1μg/kg 右美托咪定组的瑞芬太尼输注率也较低（0.089[0.080, 0.095]μg/kg/min），而安慰剂组（0.103[0.095, 0.106]μg/kg/min）：变化百分比-13.7%；95%置信区间-5.47 至-21.0；p=0.022。然而，0.25 或 0.5μg/kg 右美托咪定组的丙泊酚和瑞芬太尼输注率均无显著差异。在麻醉后恢复室，任何右美托咪定组的疼痛或镇静评分均无差异，出院时间也无明显延长。