A comparative study of dexmedetomidine with midazolam and midazolam alone for sedation during elective awake fiberoptic intubation
A comparative study of dexmedetomidine with midazolam and midazolam alone for sedation during elective awake fiberoptic intubation
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DOI：
10.1016/j.jclinane.2009.02.016
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发表时间：
2010-02-01
影响因子：
6.7
通讯作者：
Do, Kevin Sage
中科院分区：
文献类型：
--
作者：
Bergese, Sergio D.;Bender, Stephen Patrick;Do, Kevin Sage
研究目的：评价右美托咪定联合咪达唑仑（DEX-MDZ）与单用咪达唑仑（MDZ）在清醒光纤插管（AFOI）期间镇静的有效性。设计：随机、双盲研究。设置：学术医学中心。受试者：55名阿萨身体状态I、II、III和IV级患者，年龄18-85岁，计划接受AFOI非急诊手术。干预措施：所有患者均接受静脉注射（IV）格隆溴铵0.2 mg术前用药、鼻插管吸氧和气道局部局部麻醉剂。MDZ受试者接受IV咪达唑仑0.05 mg/kg和额外剂量，以达到Ramsay镇静量表（RSS）评分>= 2。DEX-MDZ患者接受咪达唑仑0.02 mg/kg，随后接受右美托咪定1 μ g/kg，然后输注右美托咪定0.1 μ g/kg/hr，并滴定至0.7 μ g/kg/hr以达到RSS >= 2。测量：评估观察者的警觉/镇静评估（OAA/S）和RSS。麻醉师评定AFOI易于放置。两名观察员在三个时间点对患者的舒适度和对放置的反应进行评分：预氧合、引入纤维喉镜时和术前引入气管插管（ET）时。手术后，患者被问到，如果他们回忆起AFOI，并评价他们的满意度与intubation.Results：DEX-MDZ患者显着平静，更合作的AFOI期间，并有较少的不良反应，AFOI比MDZ患者。他们对AFOI的满意度也高于单用咪达唑仑的患者（P < 0.001）。两个受试者组之间没有显着的血流动力学差异。结论：右美托咪定与低剂量的咪达唑仑联合使用比单独使用咪达唑仑在AFOI中镇静更有效。(C)2010年爱思唯尔公司All rights reserved.
Study Objective: To evaluate the efficacy of dexmedetomidine with midazolam (DEX-MDZ) versus midazolam only (MDZ) for sedation during awake fiberoptic intubation (AFOI).Design: Randomized, double-blinded study.Setting: Academic medical center.Subjects: 55 ASA physical status I, II, III, and IV patients, aged 18-85 years, scheduled for non-emergency surgery with AFOI.Interventions: All patients received intravenous (IV) glycopyrrolate 0.2 mg premedication, oxygen by nasal cannula, and topical local anesthetics to the airway. MDZ subjects received IV midazolam 0.05 mg/kg with additional doses to achieve a Ramsay Sedation Scale (RSS) score of >= 2. DEX-MDZ patients received midazolam 0.02 mg/kg followed by dexmedetomidine one mu g/kg, then an infusion of dexmedetomidine 0.1 mu g/kg/hr and titrated to 0.7 mu g/kg/hr to achieve RSS >= 2.Measurements: Observers' Assessment of Alertness/Sedation (OAA/S) and RSS were evaluated. The anesthesiologist rated AFOI ease of placement. Two observers rated patients' comfort and reaction to placement at three time points: preoxygenation, at introduction of the fiberoptic laryngoscope, and at introduction of the endotracheal tube (ET) before surgery. Following surgery, patients were asked if they recalled the AFOI and also to rate their satisfaction with the intubation.Results: DEX-MDZ patients were significantly calmer and more cooperative during AFOI and had fewer adverse reactions to AFOI than did the MDZ patients. They also were more satisfied with the AFOI (P < 0.001) than were the midazolam-only patients. There were no significant hemodynamic differences between the two subject groups.Conclusions: Dexmedetomidine in combination with low doses of midazolam is more effective than midazolam alone for sedation in AFOI. (C) 2010 Elsevier Inc. All rights reserved.