Efficacy of dexmedetomidine in suppressing cardiovascular and hormonal responses to general anaesthesia for caesarean delivery: a dose-response study
Efficacy of dexmedetomidine in suppressing cardiovascular and hormonal responses to general anaesthesia for caesarean delivery: a dose-response study
复制标题
DOI：
10.1016/j.ijoa.2012.04.006
复制
发表时间：
2012-07-01
影响因子：
2.8
通讯作者：
Al-Juhaiman, R. A.
中科院分区：
文献类型：
--
作者：
El-Tahan, M. R.;Mowafi, H. A.;Al-Juhaiman, R. A.
背景资料：术前右美托咪定给药可减弱对气管插管的血流动力学和激素反应，并减少麻醉需求。我们假设右美托咪定会减少择期剖腹产的产妇血液动力学和激素反应，而不会对新生儿产生有害影响。方法：在伦理批准后，68名计划在全身麻醉下进行选择性剖腹产的产妇被随机分配接受安慰剂，或0.2，诱导前20分钟静脉注射0.4或0.6 μ g/kg/h右美托咪定（每组n = 17）。使用丙泊酚和琥珀胆碱的快速顺序技术诱导麻醉，并以0.5-0.75最小肺泡浓度的七氟烷维持麻醉。记录孕妇心率、平均血压、七氟醚最低肺泡浓度、子宫张力、血清皮质醇水平、Apgar评分、神经适应能力评分和酸碱状态的变化。结果：诱导后，接受右美托咪定的患者心率增加幅度小于安慰剂组（P < 0.001）。接受0.4和0.6 μ g/kg/h右美托咪定输注的患者心率较慢（分别为-21.5%和-36%; P < 0.001），平均血压降低（分别为-17%和-25%; P < 0.001），七氟烷最低肺泡浓度（分别为-40%和-44.5%; P < 0.001）和血清皮质醇水平（分别为-27%和-34.6%; P < 0.001），拔管后前15分钟镇静评分较高，子宫张力较大（P < 0.002）。Apgar评分，NACS和酸碱状态是相似的四groups.Conclusion：右美托咪定0.4和0.6 μ g/kg/h的术前管理是有效的减弱产妇的血液动力学和激素反应七氟烷麻醉下剖腹产，没有不良的新生儿影响。(C)2012爱思唯尔有限公司保留所有权利。
Background: Preoperative dexmedetomidine administration blunts haemodynamic and hormonal responses to tracheal intubation and reduces anaesthetic requirements. We hypothesized that dexmedetomidine would reduce the maternal haemodynamic and hormonal responses to elective caesarean delivery without harmful neonatal effects.Methods: After ethical approval, 68 parturients scheduled for elective caesarean delivery under general anaesthesia were randomly allocated to receive either placebo, or 0.2, 0.4 or 0.6 mu g/kg/h intravenous dexmedetomidine (n = 17 per group) 20 min before induction. Anaesthesia was induced using a rapid-sequence technique with propofol and suxamethonium, and was maintained with 0.5-0.75 minimum alveolar concentration sevoflurane. Changes in maternal heart rate, mean blood pressure, minimum alveolar concentration sevoflurane, uterine tone, serum cortisol level, and Apgar scores, Neurologic Adaptive Capacity Scores and acid base status were recorded.Results: After induction, patients receiving dexmedetomidine had smaller increases in heart rate (P < 0.001) than those in the placebo group. Patients who received 0.4 and 0.6 mu g/kg/h infusions of dexmedetomidine showed slower heart rates (-21.5% and -36%, respectively; P < 0.001), lower mean blood pressures (-17% and -25%, respectively; P < 0.001), sevoflurane minimum alveolar concentrations (-40% and -44.5%, respectively; P < 0.001) and serum cortisol levels (-27% and -34.6%, respectively; P < 0.001) and higher sedation scores for the first 15 min after extubation and greater uterine tone (P < 0.002). Apgar scores, NACS and acid base status were similar in the four groups.Conclusion: Preoperative administration of dexmedetomidine 0.4 and 0.6 mu g/kg/h is effective in attenuating the maternal haemodynamic and hormonal responses to caesarean delivery under sevoflurane anaesthesia without adverse neonatal effects. (C) 2012 Elsevier Ltd. All rights reserved.