右美托咪定对智障儿童全麻下牙科治疗苏醒期躁动的影响
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摘要
目的研究右美托咪定是否能够减少智障儿童全麻下齿科治疗苏醒期躁动。方法选择需要行非住院全麻下齿科治疗的智障儿童49例,随机分为对照组(Con组)和右美托咪定组(Dex组)。常规七氟醚诱导后,依次静脉注射芬太尼2-3μg/kg,丙泊酚2-3mg/kg,苯黄顺阿曲库铵0.1-0.2mg/kg后,行气管插管,以2%七氟醚、100%氧气维持麻醉。手术结束前0.5h,2组患者分别静脉泵入生理盐水或右美托咪定(0.5μg/kg)。术毕记录生命体征、苏醒期躁动发生率及PAED评分。结果右美托咪定用药对手术时间、麻醉时间、拔管时间、七氟醚用量无明显影响;右美托咪定可以有效降低术后躁动的发生,PAED评分显著下降,并可降低心率。结论智障儿童全麻下齿科治疗中,使用右美托咪定可以降低术后躁动的发生率。
Objective To investigate the effect of dexmedetomidine on emergence agitation following general anesthesia in mentally retarded children for dental treatment.Methods 49 mentally retarded children,ASA status I or II,scheduled for dental treatment under general anesthesia were enrolled in this study,who were randomly divided into Control(Ctrl group,n=23)and Dexmedetomidine(Dex group,n=26)Group.Anesthesia was induced with sevoflurane,with iv injection of fentanyl 2-3μg/kg,propofol 2-3 mg/kg,and cisatracurium besilate for injection0.15 mg/kg.After intratracheal intubation,anesthesia were maintained with 2%sevoflurane and 100%oxygen.0.5 hbefore the end of surgery,0.5μg/kg dexmedetomidine or equal volume of normal saline were iv injected within 10 min for Dex group and Ctrl group respectively.Sevoflurane was shut down when the surgery were finished.Patients' medical information and vital signs,emergence agitation and PAED score were recorded.Results Dexmedetomidine did not affect the surgery time,anesthesia time,extubation time and dose of sevoflurane,but effectively decrease the emergence agitation and PAED score,as well as the heart rate.Conclusion For mentally retarded children scheduled for dental treatment under general anesthesia,dexmedetomidine can effectively reduce the emergence agitation.
Objective To investigate the effect of dexmedetomidine on emergence agitation following general anesthesia in mentally retarded children for dental treatment.Methods 49 mentally retarded children,ASA status I or II,scheduled for dental treatment under general anesthesia were enrolled in this study,who were randomly divided into Control(Ctrl group,n=23)and Dexmedetomidine(Dex group,n=26)Group.Anesthesia was induced with sevoflurane,with iv injection of fentanyl 2-3μg/kg,propofol 2-3 mg/kg,and cisatracurium besilate for injection0.15 mg/kg.After intratracheal intubation,anesthesia were maintained with 2%sevoflurane and 100%oxygen.0.5 hbefore the end of surgery,0.5μg/kg dexmedetomidine or equal volume of normal saline were iv injected within 10 min for Dex group and Ctrl group respectively.Sevoflurane was shut down when the surgery were finished.Patients' medical information and vital signs,emergence agitation and PAED score were recorded.Results Dexmedetomidine did not affect the surgery time,anesthesia time,extubation time and dose of sevoflurane,but effectively decrease the emergence agitation and PAED score,as well as the heart rate.Conclusion For mentally retarded children scheduled for dental treatment under general anesthesia,dexmedetomidine can effectively reduce the emergence agitation.
引文
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[9]柴冬冬,纪均.右美托咪定复合七氟烷在儿童口腔全麻治疗中的效果评价[J].上海口腔医学,2018,27(1):85.
[10]Tsiotou AG,Malisiova A,Kouptsova E,et al.Dexmedetomidine for the reduction of emergence delirium in children undergoing tonsillectomy with propofol anesthesia:A double-blind,randomized study[J].Paediatr Anaesth,2018,28(7):632.
[11]Shirakami G,Tanimoto K,Matsuura S,et al.Ambulatory anesthesia for an adult patient with autism and epilepsy:sedation using oral and intravenous dexmedetomidine[J].Masui,2008,57(6):735.
[12]Shikha Jain,Sameer Sethi,Babita Ghai,et al.Effect of dexmedetomidine on emergence agitation using desflurane in pediatric cataract surgery[J].Saudi J Anaesth,2018,12(1):28.
[13]Prabhu MK,Mehandale SG.Comparison of oral dexmedetomidine versus oral midazolam as premedication to prevent emergence agitation after sevoflurane anaesthesia in paediatric patients[J].Indian J Anaesth,2017,61(2):131.
[14]Fujisawa T,Komasawa N,Fujiwara A,et al.Effective Dexmedetomidine Administration for the Prevention of Emergence Agitation and Postoperative Delirium in Patients with a History of Postoperative Delirium[J].Masui,2016,65(4):395.
[15]Boyd BC,Sutter SJ.Dexmedetomidine sedation for awake fiberoptic intubation of patients with difficult airways due to severe odonto-genic cervicofacial infections[J].J Oral Maxillofac Surg,2011,69(6):1608.
[16]王磊,娄锋,张媛,等.不同剂量右美托咪定术前滴鼻对扁桃体摘除术患儿安全性的影响[J].山东大学耳鼻喉眼学报,2016,30(5):115.
[17]胡潇,付海滨,张旭.静脉注射不同剂量右美托咪定对全喉切除术后患者呛咳和躁动的影响[J].复旦学报(医学版),2016,43(5):586.
[2]Prabhu MK,Mehandale SG.Comparison of oral dexmedetomidine versus oral midazolam as premedication to prevent emergence agitation after sevoflurane anaesthesia in paediatric patients[J].Indian J Anaesth,2017,61(2):131.
[3]Sottas CE,Anderson BJ.Dexmedetomidine:the new all-in-one drug in paediatric anaesthesia[J].Curr Opin Anaesthesiol,2017,30(4):441.
[4]FitzSimons J,Bonanno LS,Pierce S,et al.Effectiveness of preoperative intranasal dexmedetomidine,compared with oral midazolam,for the prevention of emergence delirium in the pediatric patient undergoing general anesthesia:a systematic review[J].JBIDatabase System Rev Implement Rep,2017,15(7):1934.
[5]Sikich N,Lerman J.Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale[J].Anesthesiology,2004,100(5):1138.
[6]Lee Y,Kim J,Kim S,et al.Intranasal administration of dexmedetomidine(DEX)as a premedication for pediatric patients undergoing general anesthesia for dental treatment[J].J Dent Anesth Pain Med,2016,16(1):25.
[7]Aouad MT,Zeeni C,Al Nawwar R,et al.Dexmedetomidine for Improved Quality of Emergence From General Anesthesia:ADose-Finding Study[J].Anesth Analg,2017,10:1213.
[8]Jo YY,Kim HS,Lee KC,et al.Consort the effect of intraoperative dexmedetomidine on hemodynamic responses during emergence from nasotracheal intubation after oral surgery[J].Medicine(Baltimore),2017,96(16):e6661.
[9]柴冬冬,纪均.右美托咪定复合七氟烷在儿童口腔全麻治疗中的效果评价[J].上海口腔医学,2018,27(1):85.
[10]Tsiotou AG,Malisiova A,Kouptsova E,et al.Dexmedetomidine for the reduction of emergence delirium in children undergoing tonsillectomy with propofol anesthesia:A double-blind,randomized study[J].Paediatr Anaesth,2018,28(7):632.
[11]Shirakami G,Tanimoto K,Matsuura S,et al.Ambulatory anesthesia for an adult patient with autism and epilepsy:sedation using oral and intravenous dexmedetomidine[J].Masui,2008,57(6):735.
[12]Shikha Jain,Sameer Sethi,Babita Ghai,et al.Effect of dexmedetomidine on emergence agitation using desflurane in pediatric cataract surgery[J].Saudi J Anaesth,2018,12(1):28.
[13]Prabhu MK,Mehandale SG.Comparison of oral dexmedetomidine versus oral midazolam as premedication to prevent emergence agitation after sevoflurane anaesthesia in paediatric patients[J].Indian J Anaesth,2017,61(2):131.
[14]Fujisawa T,Komasawa N,Fujiwara A,et al.Effective Dexmedetomidine Administration for the Prevention of Emergence Agitation and Postoperative Delirium in Patients with a History of Postoperative Delirium[J].Masui,2016,65(4):395.
[15]Boyd BC,Sutter SJ.Dexmedetomidine sedation for awake fiberoptic intubation of patients with difficult airways due to severe odonto-genic cervicofacial infections[J].J Oral Maxillofac Surg,2011,69(6):1608.
[16]王磊,娄锋,张媛,等.不同剂量右美托咪定术前滴鼻对扁桃体摘除术患儿安全性的影响[J].山东大学耳鼻喉眼学报,2016,30(5):115.
[17]胡潇,付海滨,张旭.静脉注射不同剂量右美托咪定对全喉切除术后患者呛咳和躁动的影响[J].复旦学报(医学版),2016,43(5):586.