Breazu Caius Mihai, Maniu Alma Aurelia, Marchis Ioan Florin, Negrut Matei Florin, Ciocan Răzvan Alexandru, Mihăileanu Florin Vasile, Necula Violeta
1st Department of Anesthesia and Intensive Care, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400347 Cluj Napoca, Romania.
Department of Anesthesia and Intensive Care "Clinicilor 4-6", Cluj County Emgency Clinical Hospital, 400349 Cluj Napoca, Romania.
J Clin Med. 2025 Apr 22;14(9):2869. doi: 10.3390/jcm14092869.
Otosclerosis causes progressive hearing loss through abnormal bone remodeling within the otic capsule and predominantly affects young individuals. Surgical intervention can markedly enhance a patient's quality of life and socio-economic status. Anesthetic management may involve either general anesthesia or monitored anesthesia care, with the latter enabling real-time assessment of hearing improvement while providing optimal surgical conditions and patient satisfaction. This study examines the efficacy and safety of continuous dexmedetomidine infusion and target-controlled remifentanil infusion for conscious sedation combined with local anesthesia in otosclerosis surgery. Seventy-four adult patients undergoing otosclerosis surgery were randomly assigned to either the dexmedetomidine group or the remifentanil group. Primary outcomes included patient satisfaction at 24 h post-surgery and surgeon satisfaction with operative conditions. Secondary outcomes comprised hemodynamic effects, the necessity for adjuncts to the proposed sedation protocols, and intra- and postoperative complications. There was no statistically significant difference between the dexmedetomidine and remifentanil groups regarding patient satisfaction ( = 0.943) and surgeon satisfaction ( = 0.069). A strong correlation was observed between surgeons' assessments and patients' satisfaction Composite Scores (η = 0.185, = 0.003). Dexmedetomidine was more effective in significantly reducing arterial pressure and heart rate without undesirable clinical effects. : No significant difference was found between the groups concerning patient and surgeon satisfaction. Dexmedetomidine infusion led to considerable reductions in arterial pressure and heart rate compared to remifentanil.
耳硬化症通过耳囊内异常的骨重塑导致进行性听力丧失，主要影响年轻人。手术干预可显著提高患者的生活质量和社会经济地位。麻醉管理可采用全身麻醉或监护麻醉，后者能在提供最佳手术条件和患者满意度的同时实时评估听力改善情况。本研究探讨持续输注右美托咪定和靶控输注瑞芬太尼用于耳硬化症手术局部麻醉下清醒镇静的有效性和安全性。74例接受耳硬化症手术的成年患者被随机分为右美托咪定组或瑞芬太尼组。主要结局包括术后24小时患者满意度和外科医生对手术条件的满意度。次要结局包括血流动力学效应、拟用镇静方案辅助药物的必要性以及术中和术后并发症。右美托咪定组和瑞芬太尼组在患者满意度（=0.943）和外科医生满意度（=0.069）方面无统计学显著差异。观察到外科医生的评估与患者满意度综合评分之间存在强相关性（η=0.185，=0.003）。右美托咪定在显著降低动脉压和心率方面更有效，且无不良临床效应。：两组在患者和外科医生满意度方面无显著差异。与瑞芬太尼相比，输注右美托咪定导致动脉压和心率显著降低。
