Dexmedetomidine can stabilize hemodynamics and spare anesthetics before cardiopulmonary bypass
Dexmedetomidine can stabilize hemodynamics and spare anesthetics before cardiopulmonary bypass
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DOI：
10.1007/s00540-011-1215-3
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发表时间：
2011-12-01
影响因子：
2.8
通讯作者：
Iwasaki, Hiroshi
中科院分区：
文献类型：
--
作者：
Kunisawa, Takayuki;Ueno, Megumi;Iwasaki, Hiroshi
我们先前证实了右旋美托咪啶（DEX）在经历心脏手术的患者的麻醉诱导期间稳定血流动力学以及节省麻醉剂的有效性（Kunisawa等人，J Clin Anesth 21：194-199，1）。在本研究中，我们研究了DEX的这些作用是否持续到体外循环（CPB）开始。22例轻至中度心血管疾病患者随机分为两组[DF 2组：DEX初始剂量后0.7 μ g/kg/h，效应室浓度（ESC）为2 ng/ml的芬太尼; PF 4组：生理盐水和ESC为4 ng/ml的芬太尼]。给予丙泊酚进行麻醉诱导和维持。结果：DEX组术前、术后血压（137 ± A17/140 ± A16 mmHg）均高于安慰剂组（85 ± A9/109 ± A24 mmHg）; DEX组对SI或St的心血管反应增加百分比低于安慰剂组（例如，SI引起的收缩压为1.9 +/- A 2.2 vs. 27.4 +/- A 19.9%）。DEX组SI和St时丙泊酚ESC低于安慰剂组，CPB前DEX联合2ng/ml芬太尼可抑制SI前后的血压下降，减弱SI和St时的心血管反应，且不受芬太尼浓度的影响，丙泊酚ESC仅为安慰剂组的一半。
We previously confirmed the effectiveness of dexmedetomidine (DEX) for stabilizing hemodynamics as well as sparing anesthetics during anesthetic induction in patients undergoing cardiac surgery (Kunisawa et al. in J Clin Anesth 21:194-199, 1). In this study, we investigated whether these effects of DEX continue until the start of cardiopulmonary bypass (CPB).Twenty-two patients with mild to moderate cardiovascular disease were randomized into two groups [DF2 group: DEX dose of 0.7 mu g/kg/h after initial dose and effect-site concentration (ESC) of fentanyl of 2 ng/ml; PF4 group: saline and ESC of fentanyl of 4 ng/ml]. Propofol was administered for anesthetic induction and maintenance. Hemodynamics, cardiovascular drugs, ESC of propofol, and cardiovascular responses to skin incision (SI) and sternotomy (St) were measured or calculated.Blood pressure (BP) at the pre-/post-SI periods was higher in the DEX group (137 +/- A 17/140 +/- A 16 mmHg) than in the placebo group (85 +/- A 9/109 +/- A 24 mmHg). Percent increases in cardiovascular response to SI or St were lower in the DEX group than in the placebo group (for example, 1.9 +/- A 2.2 vs. 27.4 +/- A 19.9% in systolic BP due to SI). ESCs of propofol at SI and St in the DEX group were lower than those in the placebo group.DEX combined with 2 ng/ml fentanyl before CPB can suppress the decrease in blood pressure at the pre- and post-SI periods, can blunt the cardiovascular responses to SI and St, and can spare the required ESC of propofol despite fentanyl concentration, which was half of that in the placebo group.