Xiang Zhen,Wei Siwei,Yu Eryou,et al.Effects of different doses of dexmedetomidine on monitoring the depth of anesthesia during general anesthesia of sevoflurane in children[J].Journal of Clinical Pediatric Surgery,2023,22(04):361-366.[doi:10.3760/cma.j.cn101785-202205085-012]
不同剂量右美托咪定对小儿七氟醚全身麻醉中麻醉深度的影响研究
- Title:
- Effects of different doses of dexmedetomidine on monitoring the depth of anesthesia during general anesthesia of sevoflurane in children
- Keywords:
- Dexmedetomidine; Sevoflurane; Administration &; Dosage; Anesthesia and Analgesia
- 摘要:
- 目的 观察不同剂量右美托咪定对小儿七氟醚全身麻醉中麻醉深度的影响。方法 本研究为前瞻性研究。纳入2020年7月至2022年2月在湖南省儿童医院择期行全身麻醉复合骶管麻醉下隐匿型阴茎整复术及尿道成形+阴茎屈曲矫正术的120 例患儿为研究对象,年龄6~12岁,ASA分级Ⅰ~Ⅱ级。采用随机数字表法将患儿分为4组:C组(生理盐水组)、D1组(右美托咪定0.25 μg·kg-1·h-1)、D2组(右美托咪定0.5 μg·kg-1·h-1)和D3组(右美托咪定0.75 μg·kg-1·h-1),每组各30例。均采用七氟醚吸入诱导,置入喉罩后在超声引导下行骶管阻滞麻醉。记录右美托咪定用药前 (T0)、用药后5 min(T1)、手术开始时(T2)、手术开始后15 min(T3)、手术开始后30 min(T4)、手术结束时(T5)、拔除喉罩时(T6)、呼之争眼时(T7)以及定向力恢复时(T8)共9个时间点的麻醉深度监测数值,记录患儿术中各时间点的呼气末七氟醚浓度(ETsevo)、心率(heart rate,HR)及平均动脉压(mean arterial pressure,MAP)。术后第2天对患儿及其家属进行随访,了解患儿是否出现术中知晓或其他术后精神、行为改变等。结果 四组患儿术中脑电双频指数(bispectral index,BIS):D3组BIS值在T1、T2、T3、T4、T5时间点较C组和D1组均明显降低(P＜0.05);D3组在T4、T5时间点的BIS值明显低于D2组(P＜0.05);D1组在T0~T8各时间点的BIS值与C组比较,差异无统计学意义(P>0.05)。四组患儿术中的ETsevo变化:术中T1、T2、T3、T4、T5、T6各时间点,D2和D3组的ETsevo均较C组和D1组明显降低(P＜0.05),除T2时间点,D1组在T0、T1、T3、T4、T5、T6的ETsevo与C组比较,差异无统计学意义(P>0.05)。D3组和D2组之间比较差异无统计学意义(P>0.05)。四组患儿术中不同时间点的血流动力学:与C组相比,D1、D2和D3组在T3、T4、T5、T6的MAP明显降低(P＜0.05);D1、D2和D3组患儿的HR在T3、T4、T5、T6时间点明显低于C组(P＜0.05);D3组患儿的HR在T6~T8 3个时间点均低于C、D1和D2组(P＜0.05)。四组患儿无一例出现术中知晓以及术后精神、行为改变。结论 儿童术中持续泵入0.25 μg·kg-1·h-1的右美托咪定不会影响七氟醚麻醉的深度;超过0.5 μg·kg-1·h-1剂量的右美托咪定持续泵注可能会增加术中七氟醚的麻醉深度。
- Abstract:
- Objective To observe the effect of different doses of dexmedetomidine (dex) on the depth monitoring of anesthesia during general anesthesia of sevoflurane in children.Methods For this prospective study,120 children aged 6-12 years with ASA grade Ⅰ-Ⅱ underwent elective general anesthesia plus sacral canal anesthesia for cryptic penile reconstruction and urethroplasty plus penile flexion correction from July 2020 to February 2022.They were randomized into four groups of C (normal saline),D1 (Dex 0.25 μg·kg-1·h-1),D2 (Dex 0.5 μg·kg-1·h-1) and D3 (Dex 0.75 μg·kg-1·h-1)(n=30 each).All of them were induced by an inhalation of sevoflurane and anesthesia under sacral tube block under ultrasonic guidance after laryngeal masking.Dex was recorded at pre-Dex (T0),5 min post-Dex (T1),at the start of operation (T2),15 min after the start of operation (T3) and 30 min after the start of operation.Depth of anesthesia was monitored at 9 timepoints,including T4 at 30 min post-operation,T5 at the end of operation,T6 at the time of laryngeal mask removal,T7 at the time of eye movement and T8 at the time of orientation recovery.Etsevoflurane concentration (ETsevo),mean arterial pressure (MAP) and heart rate (HR) were recorded at all intraoperative timepoints.The children and their families were followed up at Day 2 post-operation to check whether or there was any intraoperative awareness or other postoperative mental and behavioral changes.Results Intraoperative anesthesia depth (BIS value) of four groups:BIS value group declined more markedly in group D3 at T1/T2/T3/T4/T5 than that in group C/D1 (P<0.05); BIS value at T4/T5 was significantly lower in group D3 than that in group D2 (P<0.05).No significant difference existed in BIS value between groups D1 and C at T0 to T8 (P>0.05).ETsevo changes in four groups:At T1/T2/T3/T4/T5/T6,ETsevo was significantly lower in group D2/D3 than that in group C/D1 (P<0.05).Except for T2,ETsevo was not significantly different at T0/T1/T3/T4/T5/T6 in group D1 from that in group C (P>0.05).No significant difference existed between groups D2 and D3 (P>0.05).Hemodynamics at different timepoints in four groups:as compared with group C,MAP declined markedly at T3/T4/T5/T6 in group D1/D2/D3 (P<0.05); HR was significantly lower in group D1/D2/D3 than that in group C at T3/T4/T5/T6 (P<0.05).HR was lower in group D3 than that in group C/D1/D2 at T3/T4/T5/T6/T7/T8 (P<0.05).None in four groups showed any intraoperative awareness or postoperative mental and behavioral changes.Conclusion In children,continuous intraoperative injection of Dex 0.25 μg/kg/h does not affect the monitoring of sevoflurane depth of anesthesia.And continuous Dex infusion >0.5 μg/kg/h may boost the intraoperative depth of anesthesia of sevoflurane.
参考文献/References:
[1] Arain SR,Ebert TJ.The efficacy,side effects,and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation[J].Anesth Analg,2002,95(2):461-466.DOI:10.1213/00000539-200208000-00042.
[2] 龙旭,刘祥麟.全身麻醉下脑电双频指数用于脑性瘫痪患儿SPR手术的应用[J].中国社区医师,2020,36(1):59-60.DOI:10.3969/j.issn.1007-614x.2020.01.035. Long X,Liu XL.Application of bispectral index during SPR operation for children with cerebral palsy under general anesthesia[J].Chin Community Doct,2020,36(1):59-60.DOI:10.3969/j.issn.1007-614x.2020.01.035.
[3] Schultz B,Schultz M,Boehne M,et al.EEG monitoring during anesthesia in children aged 0 to 18 months:amplitude-integrated EEG and age effects[J].BMC Pediatr,2022,22(1):156.DOI:10.1186/s12887-022-03180-x.
[4] Bhadla S,Prajapati D,Louis T,et al.Comparison between dexmedetomidine and midazolam premedication in pediatric patients undergoing ophthalmic day-care surgeries[J].Anesth Essays Res,2013,7(2):248-256.DOI:10.4103/0259-1162.118982.
[5] Yao YS,Qian B,Lin Y,et al.Intranasal dexmedetomidine premedication reduces minimum alveolar concentration of sevoflurane for laryngeal mask airway insertion and emergence delirium in children:a prospective,randomized,double-blind,placebo-controlled trial[J].Paediatr Anaesth,2015,25(5):492-498.DOI:10.1111/pan.12574.
[6] 杜真,向珍,危思维,等.右美托咪定提高儿童日间手术舒适度的临床研究[J].临床小儿外科杂志,2020,19(7):622-626.DOI:10.3969/j.issn.1671-6353.2020.07.012. Du Z,Xiang Z,Wei SW,et al.Clinical trial of dexmedetomidine in enhancing perioperative comfort during daytime pediatric surgery[J].J Clin Ped Sur,2020,19(7):622-626.DOI:10.3969/j.issn.1671-6353.2020.07.012.
[7] Schmeling WT,Ganjoo P,Staunton M,et al.Pretreatment with dexmedetomidine:altered indices of anesthetic depth for halothane in the neuraxis of cats[J].Anesth Analg,1999,88(3):625-632.DOI:10.1213/00000539-199903000-00030.
[8] Mashour GA,Esaki RK,Tremper KK,et al.A novel classification instrument for intraoperative awareness events[J].Anesth Analg,2010,110(3):813-815.DOI:10.1213/ANE.0b013e3181b6267d.
[9] Punjasawadwong Y,Chau-In W,Laopaiboon M,et al.Processed electroencephalogram and evoked potential techniques for amelioration of postoperative delirium and cognitive dysfunction following non-cardiac and non-neurosurgical procedures in adults[J].Cochrane Database Syst Rev,2018,5(5):CD011283.DOI:10.1002/14651858.CD011283.pub2.
[10] Weber F,Walhout LC,Escher JC.The impact of NarcotrendTM EEG-guided propofol administration on the speed of recovery from pediatric procedural sedation-a randomized controlled trial[J].Paediatr Anaesth,2018,28(5):443-449.DOI:10.1111/pan.13365.
[11] Dutta A,Sethi N,Sood J,et al.The effect of dexmedetomidine on propofol requirements during anesthesia administered by bispectral index-guided closed-loop anesthesia delivery system:a randomized controlled study[J].Anesth Analg,2019,129(1):84-91.DOI:10.1213/ANE.0000000000003470.
[12] Walkden GJ,Pickering AE,Gill H.Assessing long-term neurodevelopmental outcome following general anesthesia in early childhood:challenges and opportunities[J].Anesth Analg,2019,128(4):681-694.DOI:10.1213/ANE.0000000000004052.
[13] Zhang L,Li H,Deng LY,et al.Electroencephalogram mechanism of dexmedetomidine deepening sevoflurane anesthesia[J].Front Neurosci,2022,16:913042.DOI:10.3389/fnins.2022.913042.
[14] Hayashi K,Sawa T,Matsuura M.Anesthesia depth-dependent features of electroencephalographic bicoherence spectrum during sevoflurane anesthesia[J].Anesthesiology,2008,108(5):841-850.DOI:10.1097/ALN.0b013e31816bbd9b.
[15] Jaakola ML,Salonen M,Lehtinen R,et al.The analgesic action of dexmedetomidine-a novel α2-adrenoceptor agonist-in healthy volunteers[J].Pain,1991,46(3):281-285.DOI:10.1016/0304-3959(91)90111-A.
[16] Xi CH,Sun SY,Pan CX,et al.Different effects of propofol and dexmedetomidine sedation on electroencephalogram patterns:wakefulness,moderate sedation,deep sedation and recovery[J].PLoS One,2018,13(6):e0199120.DOI:10.1371/journal.pone.0199120.
相似文献/References:
[1]欧阳帆,张治明,曾宾,等.七氟醚复合髂腹股沟-髂腹下神经阻滞用于小儿腹股沟手术[J].临床小儿外科杂志,2010,9(06):466.
备注/Memo
收稿日期:2022-5-29。
基金项目:湖南省自然科学基金(S2019JJQNJJ0583)
通讯作者:杜真,Email:meggyzhen@163.com