Effects of dexmedetomidine on oxygenation during one-lung ventilation for thoracic surgery in adults.
Effects of dexmedetomidine on oxygenation during one-lung ventilation for thoracic surgery in adults.
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DOI：
10.4103/0972-9941.85645
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发表时间：
2011-10
影响因子：
0.8
通讯作者：
Tobias JD
中科院分区：
文献类型：
--
作者：
Kernan S;Rehman S;Meyer T;Bourbeau J;Caron N;Tobias JD
评价右美托咪定对接受胸外科手术的成人患者在单肺通气（OLV）期间缺氧性肺血管收缩（HPV）和氧合的影响。前瞻性、随机、双盲试验。三级保健，大学医院。19例接受需要OLV的胸外科手术的成人患者。在地氟烷吸入麻醉期间，患者随机接受右美托咪定（推注剂量为0.3 μg/kg，随后以0.3 μg/kg/hr输注）或生理盐水安慰剂。获取三份动脉血气样本（ABG）以评估右美托咪定对氧合的影响。次要结局包括血流动力学参数（心率和平均动脉压）的差异、维持双频指数（BIS）在40-60所需的潮气末地氟烷浓度、维持血流动力学稳定的补充芬太尼和维持平均动脉压（MAP）在基线值10%以内的苯肾上腺素。右美托咪定给药后，OLV期间的氧合未发生变化（右美托咪定患者的PaO 2/FiO 2比值为188 ± 115，安慰剂患者为135 ± 70 mmHg）。两组之间的血流动力学变量或麻醉深度无差异。与对照组相比，右美托咪定给药后，维持BIS在40-60所需的地氟烷呼气浓度降低（4.5 ± 0.8% vs 5.1 ± 0.8%）。在接受右美托咪定的患者中，与安慰剂组相比，芬太尼的需求量降低（2.7 μg/kg/患者vs 3.1 μg/kg/患者）。然而，更多接受右美托咪定治疗的患者需要苯丙氨酸来维持血流动力学稳定性（9例患者中的6例vs 10例患者中的3例），并且与安慰剂相比，接受右美托咪定治疗的患者中苯丙氨酸的总剂量更大（10.3 μg/kg/患者vs 1.1 μg/kg/患者）。右美托咪定不会对接受胸外科手术的成人OLV期间的氧合产生不良影响。右美托咪定患者的氧合改善可能与吸入麻醉剂需求减少有关，从而限制了其对HPV的影响。
To evaluate the effects of dexmedetomidine on hypoxic pulmonary vasoconstriction (HPV) and oxygenation during one-lung ventilation (OLV) in adults undergoing thoracic surgery. Prospective, randomized, double-blinded trial. Tertiary care, University-based hospital. Nineteen adult patients undergoing thoracic surgery requiring OLV. During inhalational anesthesia with desflurane, patients were randomized to receive either dexmedetomidine (bolus dose of 0.3 μg/kg followed by an infusion of 0.3 μg/kg/hr) or saline placebo. Three arterial blood gas samples (ABG) were obtained to evaluate the effects of dexmedetomidine on oxygenation. Secondary outcomes included differences in hemodynamic parameters (heart rate and mean arterial pressure), end-tidal desflurane concentration required to maintain the bispectral index (BIS) at 40-60, supplemental fentanyl to maintain hemodynamic stability, and phenylephrine to keep the mean arterial pressure (MAP) within 10% of baseline values. Oxygenation during OLV did not change following the administration of dexmedetomidine (PaO2/FiO2 ratio of 188 ± 115 in dexmedetomidine patients versus 135 ± 70 mmHg in placebo patients). There were no differences in hemodynamic variables or depth of anaesthesia between the two groups. With the administration of dexmedetomidine, there was a decrease in the expired concentration of desflurane required to maintain the BIS at 40-60 when compared with the control group (4.5 ± 0.8% versus 5.1 ± 0.8%). In patients receiving dexmedetomidine, fentanyl requirements were decreased when compared to placebo (2.7 μg/kg/patient versus 3.1 μg/kg/patient). However, more patients receiving dexmedetomidine required phenylephrine to maintain hemodynamic stability (6 of 9 patients versus 3 of 10 patients) and the total dose of phenylephrine was greater in patients receiving dexmedetomidine when compared with placebo 10.3 μg/kg/patient versus 1.1 μg/kg/patient). Dexmedetomidine does not adversely affect oxygenation during OLV in adults undergoing thoracic surgical procedures. The improvement in oxygenation in the dexmedetomidine patients may be related to a decrease in the requirements for inhalational anaesthetic agents thereby limiting its effects on HPV.
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影响因子：
5.7
作者：
Talke, P;Richardson, CA;Fisher, DM
通讯作者：
Fisher, DM
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10.7
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Pennefather, SH