Dexmedetomidine infusion as a supplement to isoflurane anaesthesia for vitreoretinal surgery
Dexmedetomidine infusion as a supplement to isoflurane anaesthesia for vitreoretinal surgery
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DOI：
10.1093/bja/aem040
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发表时间：
2007-04-01
影响因子：
9.8
通讯作者：
Hung, C. T.
中科院分区：
文献类型：
--
作者：
Lee, Y. Y. S.;Wong, S. M.;Hung, C. T.
背景。我们探讨右美托咪定的交感神经溶解特性，特别是其在降低眼压、血流动力学稳定性和减少拔管反应方面的作用。在这项由医院伦理委员会批准的双盲、随机、对照试验中，60名接受选择性玻璃体视网膜手术的患者被分为两组，分别接受安慰剂或右美托咪定治疗。在异丙酚诱导麻醉前立即输注负荷剂量2.5 μ g kg(-1) h（-1）的右美托咪定（或相同体积的安慰剂）10分钟，随后继续输注0.4 μ g kg(-1) h（-1）的右美托咪定或安慰剂，直至手术结束前30分钟。用异氟烷、氧气和空气混合物维持麻醉。在给药前和气管插管后1 min分别测定IOP。测量负荷、诱导、维持、拔管和恢复期间的平均动脉压（MAP）和心率（HR）。拔管时的应变程度分为0 ~ 5级。抗利尿激素/拉贝他洛尔/阿托品的使用和眼压降低在两组之间具有可比性。MAP和HR随时间在组内有显著差异，但组间无显著差异。右美托咪定组患者的中位应变程度显著低于右美托咪定组（P=0.049），达到Aldrete评分10分的时间显著缩短（P=0.031）。右美托咪定可以在没有过度血流动力学波动的情况下使用，并且可以减少拔管时的兴奋反应。右美托咪定降低IOP的效果与安慰剂相当。
Background. We explored the sympatholytic property of dexmedetomidine, especially its role in intraocular pressure (IOP) reduction, haemodynamic stability, and attenuation of extubation response.Method. In this double-blind, randomized, controlled trial approved by the Hospital Ethics Committee, 60 patients undergoing elective vitreoretinal surgery were allocated to two groups, receiving either placebo or dexmedetomidine. A loading dose of dexmedetomidine 2.5 mu g kg(-1) h(-1) (or placebo in same volume) was infused for 10 min immediately before induction of anaesthesia with propofol, followed by a maintenance dexmedetomidine or placebo infusion at 0.4 mu g kg(-1) h(-1) till 30 min before the end of the operation. Anaesthesia was maintained with isoflurane, oxygen, and air mixture. IOP was measured before the loading dose and I min after tracheal intubation. The mean arterial pressure (MAP) and heart rate (HR) during loading, induction, maintenance, extubation, and recovery period were measured. The degree of strain on extubation was graded from 0 to 5.Results. The use of vasopressor/labetalol/atropine and the reduction in IOP were comparable between the two groups. There was a significant variation in MAP and HR over time within group, but not between groups. The median degree of strain was significantly lower (P=0.049), and the time to reach Aldrete score of 10 shorter (P=0.031) in the dexmedetomidine group.Conclusion. Dexmedetomidine can be used without undue haemodynamic fluctuation and can decrease the excitatory response during extubation. The reduction in IOP with dexmedetomidine was comparable with placebo.