右美托咪定经口腔黏膜给药对全麻患儿拔管期应激反应的影响
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摘要
目的探讨右美托咪定经口腔黏膜给药对腹腔镜疝囊高位结扎患儿拔管期应激反应和苏醒质量的影响。方法择期全麻下行腹腔镜疝囊高位结扎术的患儿200例,年龄2～5岁,男128例,女72例,ASAⅠ级,采用随机数字表法分为4组,每组50例。不同剂量右美托咪定组(D1组、D2组、D3组)麻醉诱导前经口腔黏膜喷雾给予右美托咪定0.5、1.0和2.0μg/kg,C组用生理盐水喷雾。记录患儿给药即刻(T0)、手术结束时(T1)、拔管时(T2)、拔管后5 min(T3)、10 min(T4)、30 min(T5)的平均动脉压(MAP)和心率(HR)。采集外周静脉血,测定基础值、拔管时和拔管后30 min的血糖和血清皮质醇浓度;观察并记录术后睁眼时间、拔管时间、瑞芬太尼用量、评估小儿麻醉苏醒期躁动评分(PAED)评分、改良加拿大东安大略儿童医院疼痛评分(m-CHEOPS)和不良反应(喉痉挛、恶心呕吐、苏醒延迟等)的发生情况。结果与C组比较,T2～T4时的D1组、T1～T5时D2、D3组MAP明显降低和HR明显减慢(P<0.05)。C组、D1组和D2组睁眼时间、拔管时间明显短于D3组(P<0.05),D2组和D3组拔管质量评分明显低于C组和D1组,瑞芬太尼用量C组明显大于其他3组,差异有统计学意义(P<0.05),C组和D1组血糖和血清皮质醇浓度在拔管时和拔管后30 min明显高于基础值(P<0.05)。患儿拔管后入PACU,D2组和D3组患儿术后烦躁发生率、PAED评分和m-CHEOPS评分均低于D1组和C组(P<0.05),D3组仅有1例患儿出现嗜睡,其他患儿未见不良反应。结论术前经口腔黏膜给予1.0或2.0μg/kg右美托咪定能有效抑制苏醒拔管期应激反应,维持血流动力学稳定,降低躁动的发生。
Objective To investigate the influence of dexmedetomidine by buccal mucosa administration on the stress response and recovery quality during extubation in children undergoing laparoscopic hernia operation. Methods Two hundreds pediatric patients scheduled for laparoscopic hernia operation, with ASA I, aged 2-5 years old were included(128 males and 72 females). The children were randomly divided into 4 groups, normal saline control group(Group C); and 3 groups with different doses of dexmedetomidine, Groups D1, D2 and D3, in which buccal mucsa administration of dexmedetomidine by 0.5 μg/kg, 1.0 μg/kg and 2.0 μg/kg, respectively, were given before anesthesia induction. The participants in Group C were given with normal saline as placebo. The MAP and HR were recorded immediately after administration(T0), at the end of surgery(T1), at extubation(T2), 5 min after extubation(T3), 10 min after extubation(T4), and 30 min after extubation(T5). Peripheral venous blood was collected to measure the blood glucose and serum cortisol concentrations at baseline, at extubation and 30 min after extubation. Postoperative recovery time, extubation time, remifentanil dosage, pediatric anesthesia recovery agitation score(PAED), modified pain score(m-CHEOPS) and adverse reactions(laryngeal spasm, nausea and vomiting and delayed recovery) were observed and recorded. Results Compared with Group C, The MAP and HR were significantly reduced in Group D1 at T2-T4; and so were in Group D2 and D3 at T1-T5(P<0.05). Awaken time and extubation time were significantly shorter in Group C, D1 and D2 when compared with Group D3(P<0.05). The extubation quality scores of Group D2 and D3 were significantly lower than thos in Group C and group D1(P<0.05). The dosage of remifentanil in Group C was significantly higher than those in the other 3 groups(P<0.05). The levels of blood glucose and serum cortisol concentration during extubation and 30 min after extubation were significantly higher than those in the Group C and D1(P<0.05). The incidence of postoperative agitation, PAED score and m-CHEOPS score in the Group D2 and D3 were significantly lower than those in Group D1 and C(P<0.05). There was no significant difference in adverse reactions among the 4 groups, though 1 drowsiness symptom was reported in Group D3. Conclusion Buccal administration of dexmedetomidine before anesthesia induction could effectively attenuate the stress response during the resuscitation at extubation, maintain the hemodynamic stability, and reduce the occurrence of agitation.
Objective To investigate the influence of dexmedetomidine by buccal mucosa administration on the stress response and recovery quality during extubation in children undergoing laparoscopic hernia operation. Methods Two hundreds pediatric patients scheduled for laparoscopic hernia operation, with ASA I, aged 2-5 years old were included(128 males and 72 females). The children were randomly divided into 4 groups, normal saline control group(Group C); and 3 groups with different doses of dexmedetomidine, Groups D1, D2 and D3, in which buccal mucsa administration of dexmedetomidine by 0.5 μg/kg, 1.0 μg/kg and 2.0 μg/kg, respectively, were given before anesthesia induction. The participants in Group C were given with normal saline as placebo. The MAP and HR were recorded immediately after administration(T0), at the end of surgery(T1), at extubation(T2), 5 min after extubation(T3), 10 min after extubation(T4), and 30 min after extubation(T5). Peripheral venous blood was collected to measure the blood glucose and serum cortisol concentrations at baseline, at extubation and 30 min after extubation. Postoperative recovery time, extubation time, remifentanil dosage, pediatric anesthesia recovery agitation score(PAED), modified pain score(m-CHEOPS) and adverse reactions(laryngeal spasm, nausea and vomiting and delayed recovery) were observed and recorded. Results Compared with Group C, The MAP and HR were significantly reduced in Group D1 at T2-T4; and so were in Group D2 and D3 at T1-T5(P<0.05). Awaken time and extubation time were significantly shorter in Group C, D1 and D2 when compared with Group D3(P<0.05). The extubation quality scores of Group D2 and D3 were significantly lower than thos in Group C and group D1(P<0.05). The dosage of remifentanil in Group C was significantly higher than those in the other 3 groups(P<0.05). The levels of blood glucose and serum cortisol concentration during extubation and 30 min after extubation were significantly higher than those in the Group C and D1(P<0.05). The incidence of postoperative agitation, PAED score and m-CHEOPS score in the Group D2 and D3 were significantly lower than those in Group D1 and C(P<0.05). There was no significant difference in adverse reactions among the 4 groups, though 1 drowsiness symptom was reported in Group D3. Conclusion Buccal administration of dexmedetomidine before anesthesia induction could effectively attenuate the stress response during the resuscitation at extubation, maintain the hemodynamic stability, and reduce the occurrence of agitation.
引文
[1] 吴新民,薛张纲,马红.右美托咪定临床应用专家共识(2018)[J].临床麻醉学杂志,2018,34(8):820-823.
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[4] Li LQ,Wang C,Xu HY,et al.Effects of different doses of intranasal dexmedetomidine on preoperative sedation and postoperative agitation in pediatric with total intravenous anesthesia undergoing adenoidectomy with or without tonsillectomy[J].Medicine (Baltimore),2018,(39):12140.
[5] Di M,Han Y,Yang Z,et al.Tracheal extubation in deeply anesthetized pediatric patients after tonsillectomy:a comparison of high-concentration sevoflurane alone and low-concentration sevoflurane in combination with dexmedetomidine premedication[J].BMC Anesthesiol,2017,17(1):28-33.
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[7] Tsze DS,Ieni M,Flores-Sanchez PL,et al.Quantification of Pain and Distress Associated With Intranasal Midazolam Administration in Children and Evaluation of Validity of Four Observational Measures[J].Pediatr Emerg Care,2018,5(23):114-119.
[8] Amorim MA,Govêia CS,Magalh?es E,et al.Effect of dexmedetomidine in children undergoing general anesthesia with sevolfurane:a meta-analysia[J].Braz J Anesthesiol,2017,67(2)193-198.
[9] Li Y,Wang B,Zhang LL,et al.Dexmedetomidine Conmbined with General Anesthesia Provides Similar Intraoperative Stress Resspons Reduction When Compared with a Combined General and Epidural Anesthetic Technique[J].Anesth Analg,2016,122(4):1202-1210.
[10] Cai ZM,Wu HH,Zhang Y,et al.Sedative effect of administration of different doses of buccal dexmedetomidine in pediatric patients undergoing tonsillectomy and adenoidectomy[J].Clin Anesth,2017,33(2):113-115.
[11] Zanaty OM,El Metainy SA.A comparative evaluation of nebulized dexmedetomidine,nebu-lized ketamine,and their combination as premedication for outpatient pediatric dental Surgey[J].Anesth Analg,2015,121(1):167-171.
[12] Stesko T,Bury K,Lubowiecka I,et al.Safety and efficacy of a Ventralight ST echo ps implant for a laparoscopic ventral hernia repair-a prospective cohort study with a one-year follow-up[J].Pol Przegl Chir,2016,88(1):7-14.
[13] Juki■M,Pogoreli■ Z,?upe-Domi■ D,et al.Comparison of inflammatory stress response between laparoscopic and open approach for pediatric inguinal hernia repair in children[J].Surg Endosc,2018,3(1):1-8.
[14] Yuki k,Matsunami E,Tazawa K,et al.Pediatric Perioperative Stress Responses and Aneshesia[J].Transl Perioper Pain Med,2017,2(1):1-12.
[15] Kendall MC,Alves LJC,Suh EI,et al.Regional anesthesia to analgesia outcoes in pediatric sugical patients:an updated systematic review of randomized controlled trials[J].Local Reg Anesth,2018,11(4):91-109.
[16] Begum U,Singh PR,Naithani B,et al.Dexmetomidine as Bolus or Low-dose infusion for the Prevention of Emergence Agitation with Sevoflurane Anesthesia in Pediatric Patients[J].Anesth Essays Res,2019,13(1):57-62.
[2] Jiang L,Hu M,Lu Y,et al.The protective effects of demedetomidine on ischemic brain injury:A meta-anaIysis[J].J Clin Anesth,2017,40(12):25-32.
[3] Yang F,Liu Y,Yu Q,et al.Analysis of 17948 pediatric patients undergoing procedural sedation with a combination of intranasal dexmedetomidine and ketamine[J].Paediatr Anaesth,2019,29 (1):85-91.
[4] Li LQ,Wang C,Xu HY,et al.Effects of different doses of intranasal dexmedetomidine on preoperative sedation and postoperative agitation in pediatric with total intravenous anesthesia undergoing adenoidectomy with or without tonsillectomy[J].Medicine (Baltimore),2018,(39):12140.
[5] Di M,Han Y,Yang Z,et al.Tracheal extubation in deeply anesthetized pediatric patients after tonsillectomy:a comparison of high-concentration sevoflurane alone and low-concentration sevoflurane in combination with dexmedetomidine premedication[J].BMC Anesthesiol,2017,17(1):28-33.
[6] Amorim MA,Govêia CS,Magalh?es E,et al.Effect of dexmedetomidine in children undergoing general anesthesia with sevolfurane:a meta-analysia[J].Braz J Anesthesiol,2017,67(2)193-198.
[7] Tsze DS,Ieni M,Flores-Sanchez PL,et al.Quantification of Pain and Distress Associated With Intranasal Midazolam Administration in Children and Evaluation of Validity of Four Observational Measures[J].Pediatr Emerg Care,2018,5(23):114-119.
[8] Amorim MA,Govêia CS,Magalh?es E,et al.Effect of dexmedetomidine in children undergoing general anesthesia with sevolfurane:a meta-analysia[J].Braz J Anesthesiol,2017,67(2)193-198.
[9] Li Y,Wang B,Zhang LL,et al.Dexmedetomidine Conmbined with General Anesthesia Provides Similar Intraoperative Stress Resspons Reduction When Compared with a Combined General and Epidural Anesthetic Technique[J].Anesth Analg,2016,122(4):1202-1210.
[10] Cai ZM,Wu HH,Zhang Y,et al.Sedative effect of administration of different doses of buccal dexmedetomidine in pediatric patients undergoing tonsillectomy and adenoidectomy[J].Clin Anesth,2017,33(2):113-115.
[11] Zanaty OM,El Metainy SA.A comparative evaluation of nebulized dexmedetomidine,nebu-lized ketamine,and their combination as premedication for outpatient pediatric dental Surgey[J].Anesth Analg,2015,121(1):167-171.
[12] Stesko T,Bury K,Lubowiecka I,et al.Safety and efficacy of a Ventralight ST echo ps implant for a laparoscopic ventral hernia repair-a prospective cohort study with a one-year follow-up[J].Pol Przegl Chir,2016,88(1):7-14.
[13] Juki■M,Pogoreli■ Z,?upe-Domi■ D,et al.Comparison of inflammatory stress response between laparoscopic and open approach for pediatric inguinal hernia repair in children[J].Surg Endosc,2018,3(1):1-8.
[14] Yuki k,Matsunami E,Tazawa K,et al.Pediatric Perioperative Stress Responses and Aneshesia[J].Transl Perioper Pain Med,2017,2(1):1-12.
[15] Kendall MC,Alves LJC,Suh EI,et al.Regional anesthesia to analgesia outcoes in pediatric sugical patients:an updated systematic review of randomized controlled trials[J].Local Reg Anesth,2018,11(4):91-109.
[16] Begum U,Singh PR,Naithani B,et al.Dexmetomidine as Bolus or Low-dose infusion for the Prevention of Emergence Agitation with Sevoflurane Anesthesia in Pediatric Patients[J].Anesth Essays Res,2019,13(1):57-62.