Comparison Between Dexmedetomidine and Remifentanil for Controlled Hypotension and Recovery in Endoscopic Sinus Surgery
Comparison Between Dexmedetomidine and Remifentanil for Controlled Hypotension and Recovery in Endoscopic Sinus Surgery
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DOI：
10.1177/000348941312200702
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发表时间：
2013-07-01
影响因子：
1.4
通讯作者：
Kang, Hyerim
中科院分区：
文献类型：
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作者：
Lee, Jungah;Kim, Yongshin;Kang, Hyerim
目的：我们比较了右美托咪定和盐酸瑞芬太尼在内窥镜鼻窦手术中对术中现场状况和恢复的疗效。方法：这项前瞻性、双盲、随机研究纳入了 66 名计划接受择期内窥镜鼻窦手术的患者（美国麻醉医师协会身体状况 I 和 II）。患者被随机分为两组。两组均给予异丙酚 2 至 2.5 mg/kg 以诱导麻醉，并用地氟烷维持麻醉。一组在麻醉诱导时在10分钟内接受右美托咪定1μg/kg，随后在维持期间每小时输注0.4至0.8μg/kg，而另一组在麻醉诱导时在1分钟内接受瑞芬太尼1μg/kg，随后在维持期间每分钟输注0.2至0.4μg/kg。记录手术情况、血流动力学参数、术中失血量、拔管时间、镇静情况以及麻醉后监护室（PACU）的疼痛情况。结果：两组在术野条件、失血量或拔管时间方面无显着差异。右美托咪定组 PACU 中的镇静评分（改良观察者警觉/镇静评估）显着低于瑞芬太尼组 (p < 0.001)。两组相比，在总失血量、手术野条件、血流动力学参数、拔管时间或 PACU 疼痛方面没有发现差异 (p > 0.05)。 结论：虽然瑞芬太尼和右美托咪定均可实现低血压麻醉并为内窥镜鼻窦手术提供良好的术中视野，但瑞芬太尼在术后即刻的恢复速度比右美托咪定更快。
Objectives: We compared the efficacy of dexmedetomidine and remifentanil hydrochloride in intraoperative field conditions and recovery during endoscopic sinus surgery.Methods: Sixty-six patients (American Society of Anesthesiologists physical status I and II) scheduled for elective endoscopic sinus surgery were enrolled in this prospective, double-blinded, randomized study. The patients were randomly assigned to two groups. Propofol, 2 to 2.5 mg/kg, was administered to both groups to induce anesthesia, which was maintained with desflurane. One group received dexmedetomidine 1 mu g/kg over 10 minutes at anesthesia induction, followed by 0.4 to 0.8 mu g/kg per hour infusion during maintenance, whereas the other group received remifentanil 1 mu g/kg over 1 minute at anesthesia induction, followed by 0.2 to 0.4 mu g/kg per minute infusion during maintenance. Surgical conditions, hemodynamic parameters, intraoperative blood loss, time to extubation, sedation, and pain in the postanesthesia care unit (PACU) were recorded.Results: There were no significant differences between the two groups with respect to surgical field conditions, blood loss, or extubation time. The sedation score (Modified Observer's Assessment of Alertness/Sedation) in the PACU was significantly lower in the dexmedetomidine group than in the remifentanil group (p < 0.001). No differences were found in total blood loss, surgical field conditions, hemodynamic parameters, time to extubation, or pain in the PACU when the two groups were compared (p > 0.05).Conclusions: Although remifentanil and dexmedetomidine both enabled hypotensive anesthesia and good intraoperative fields for endoscopic sinus surgery, recovery was faster with remifentanil than with dexmedetomidine in the immediate postoperative period.