High dose dexmedetomidine as the sole sedative for pediatric MRI
High dose dexmedetomidine as the sole sedative for pediatric MRI
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DOI：
10.1111/j.1460-9592.2008.02468.x
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发表时间：
2008-05-01
影响因子：
1.7
通讯作者：
Dinardo, James A.
中科院分区：
文献类型：
--
作者：
Mason, Keira P.;Zurakowski, David;Dinardo, James A.
目的：对右美托咪定的镇静作用进行大规模回顾性评价。目的：探讨大剂量右美托咪定作为唯一镇静剂在磁共振成像（MRI）研究中的血流动力学反应、疗效和不良事件。背景：自2005年以来，右美托咪定一直在我们机构用于儿科放射影像学研究的镇静。随着时间的推移，使用大剂量右美托咪定作为唯一镇静剂的有效方案已经发展。方法/材料：作为正在进行的质量保证过程的一部分，每月对所有镇静的数据进行审查，并根据需要修改方案。对2005年4月至2007年4月接受右美托咪定MRI镇静治疗的所有747例连续患者的数据进行分析。结果：自2005年以来，我们的右美托咪定方案10 min负荷剂量从2 μ g.kg（-1）增加到3 μ g.kg(-1)，输注速度从1 μ g.kg（-1）增加到1.5 μ g.kg（-1）。目前的镇静方案使单独使用右美托咪定的镇静成功率（能够完成影像学研究）从91.8%逐渐增加到97.6% (P = 0.009)，减少了单独使用右美托咪定镇静失败时对戊巴比妥的辅助需求，并使平均恢复时间缩短了10分钟（P < 0.001）。虽然右美托咪定镇静与16%的心动过缓发生率相关，但所有伴随的平均动脉血压均在年龄调整正常范围的20%以内，血氧饱和度为95%或更高。结论：大剂量右美托咪定为儿童MRI研究提供了足够的镇静作用。虽然使用高剂量右美托咪定会导致心率和血压下降超出既定的“清醒”标准，但这种偏差通常在标准的20%以内，并且与不良后遗症无关。右美托咪定可作为儿童MRI的唯一镇静剂。
Objective: This large-scale retrospective review evaluates the sedation profile of dexmedetomidine.Aim: To determine the hemodynamic responses, efficacy and adverse events associated with the use of high dose dexmedetomidine as the sole sedative for magnetic resonance imaging (MRI) studies.Background: Dexmedetomidine has been used at our institution since 2005 to provide sedation for pediatric radiological imaging studies. Over time, an effective protocol utilizing high dose dexmedetomidine as the sole sedative agent has evolved.Methods/Materials: As part of the ongoing Quality Assurance process, data on all sedations are reviewed monthly and protocols modified as needed. Data were analyzed from all 747 consecutive patients who received dexmedetomidine for MRI sedation from April 2005 to April 2007.Results: Since 2005, the 10-min loading dose of our dexmedetomidine protocol increased from 2 to 3 mu g.kg(-1), and the infusion rate increased from 1 to 1.5 to 2 mu g.kg(-1).h(-1). The current sedation protocol progressively increased the rate of successful sedation (able to complete the imaging study) when using dexmedetomidine alone from 91.8% to 97.6% (P = 0.009), reducing the requirement for adjuvant pentobarbital in the event of sedation failure with dexmedetomidine alone and decreased the mean recovery time by 10 min (P < 0.001). Although dexmedetomidine sedation was associated with a 16% incidence of bradycardia, all concomitant mean arterial blood pressures were within 20% of age-adjusted normal range and oxygen saturations were 95% or higher.Conclusion: Dexmedetomidine in high doses provides adequate sedation for pediatric MRI studies. While use of high dose dexmedetomidine is associated with decreases in heart rate and blood pressure outside the established 'awake' norms, this deviation is generally within 20% of norms, and is not associated with adverse sequelae. Dexmedetomidine is useful as the sole sedative for pediatric MRI.