The evolving role of dexmedetomidine in pediatric cardiac surgery: Beyond anxiolysis.
The evolving role of dexmedetomidine in pediatric cardiac surgery: Beyond anxiolysis.
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右美托汀在小儿心脏手术中的不断发展的作用：超越抗焦虑。
DOI：
10.1111/jocs.16706
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发表时间：
2022-12
影响因子：
1.6
通讯作者：
Rong, Lisa Q.
中科院分区：
文献类型：
--
作者：
Scharoun, Jacques;Rong, Lisa Q.
亲爱的编辑：长期以来，人们一直认为减少小儿心脏手术的应激反应有助于降低发病率，例如预防肺动脉高压急症。[1] 1992年，Anand和Hickey最终证明了大剂量强效麻醉剂减轻这种反应的安全性和有效性，他们发现接受心脏手术的新生儿接受高剂量舒芬太尼与氟烷和低剂量吗啡相比，围手术期死亡率降低100%，总死亡率降低60%。2大剂量芬太尼方案在小儿心脏手术中成为常规。不幸的是，麻醉诱导的呼吸抑制导致术后插管和通气时间延长3，这有几个负面影响。首先，正压通气在单心室生理学中可能是不利的。双向Glenn患者拔管后自主通气时心输出量和脑饱和度改善。第二，长时间插管可导致声门下狭窄或呼吸机获得性肺炎。6第三，增加资源利用会给社会带来成本，包括增加重症监护病房住院时间（ICU-LOS）。这可能会给资源有限的医疗保健系统带来特别的压力。3这些问题导致了对早期拔管的重新关注，同时试图避免手术应激反应控制不足的后果。7 Altun等人8在最近一期的回顾性研究中提出了一项队列研究，证明了右美托咪定在促进小儿心脏手术后早期拔管方面的有效性。如果麻醉剂过量延迟拔管，那么理论上，减少术中芬太尼剂量应导致更早拔管。这不一定是真的。在一项随机前瞻性试验中，Naguib比较了给予低剂量（10 μg/kg）或高剂量（25 μg/kg）芬太尼对接受室间隔缺损（VSD）、房室管（AVC）或法洛四联症（TOF）修复的儿童的影响，发现通气量没有显著减少
Dear Editor--Reducing the stress response to pediatric cardiac surgery has long been understood to be helpful in reducing morbidity, for example by in preventing pulmonary hypertensive emergencies. 1 The safety and efficacy of potent narcotics, in large doses, to attenuate this response was conclusively demonstrated by Anand and Hickey in 1992, who showed a 100% decrease in perioperative mortality and 60% decrease in overall mortality in neonates undergoing cardiac surgery who received high-dose sufentanil vs halothane and low-dose morphine. 2 High-dose fentanyl regimens for pediatric cardiac surgery became routine. Unfortunately, narcotic-induced respiratory depression resulted in prolonged postoperative intubation and ventilation3 which has several negative effects. First, positive pressure ventilation can be disadvantageous in single-ventricle physiology. Cardiac output and cerebral saturation improve in bidirectional Glenn patients following extubation to spontaneous ventilation. 4 Second, prolonged intubation can lead to subglottic stenosis5 or ventilator acquired pneumonia. 6 Third, there is the cost to society of increased resource utilization, including increased intensive care unit length of stay (ICU-LOS). This can place a particular strain on resource-limited healthcare systems. 3 These problems led to a renewed interest in earlier extubation while trying to avoid the consequences of inadequate control of the surgical stress response. 7 The retrospective study by Altun et al8 in this recent issue presents an cohort study demonstrating the usefulness of the drug dexmedetomidine in facilitating very early extubation following pediatric cardiac surgery.If narcotic excess delays extubation, then in theory, reducing the intraoperative fentanyl dose should lead to earlier extubation. This is not necessarily true. In a randomized prospective trial, Naguib compared the impact of giving low dose (10 μg/kg) or high dose (25 μg/kg) fentanyl to children undergoing ventricular septal defect (VSD), atrioventricular canal (AVC), or Tetralogy of Fallot (TOF) repair and found no significant reduction in ventilation
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DOI：
10.1097/pcc.0b013e31828a742c
发表时间：
2013-06
期刊：
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
影响因子：
--
作者：
Naguib AN;Tobias JD;Hall MW;Cismowski MJ;Miao Y;Barry N;Preston T;Galantowicz M;Hoffman TM
通讯作者：
Hoffman TM
影响因子：
4.1
作者：
Amula, Venu;Vener, David F.;Nicolson, Susan C.
通讯作者：
Nicolson, Susan C.
影响因子：
4.5
作者：
Weerink MAS;Struys MMRF;Hannivoort LN;Barends CRM;Absalom AR;Colin P
通讯作者：
Colin P
影响因子：
--
作者：
Huang, Jihong;Zhou, Yanping;Zhu, Deming
通讯作者：
Zhu, Deming
影响因子：
1.6
作者：
Ming S;Xie Y;Du X;Huang H;Fan Y;Liang Q;Xie Y
通讯作者：
Xie Y