喉罩联合右美托咪定在神经介入手术中的应用

Dexmedetomidine combided with laryngeal mask airway used in patients undergoing endovascular coil embolization

目的比较不同剂量右美托咪定联合喉罩应用于神经介入手术的效果。方法 90例ASAⅠ、Ⅱ级在全身麻醉下行神经介入治疗颅内动脉瘤的患者随机分为3组:七氟醚和生理盐水组(对照组)、七氟醚和0.5μg/kg右美托咪定组(DEX1组)及七氟醚和1μg/kg右美托咪定组(DEX2组)。入选患者均采用丙泊酚和罗库溴铵全身麻醉诱导后,置入喉罩,术中维持七氟醚呼气末浓度为2 MAC。评价术后苏醒时间和躁动情况。结果 DEX2组术中心率减低(26.7%)发生率高于其他两组,DEX2组术后患者睁眼时间比其他两组延长近10 min。对照组术后躁动发生率较高,其他两组未见术后躁动。结论单次给予0.5μg/kg右美托咪定联合喉罩置入对神经介入治疗颅内动脉瘤患者术中的血液动力学影响较小,苏醒迅速,同时能够很好地预防术后躁动。

[Objective] We designed a double-blind, randomized placebo-controlled study to determine the effects of Dexmedetomidine （DEX） on the recovery characteristics of patients who were scheduled to un- dergo endovascular coil embolization. [Methods] After intravenous induction with Propofol and rocuronium and, laryngeal mask airway insertion, patients were randomly assigned to receive saline （Group S, n =30）, 0.5 ug/kg Dexmedetomidine （Group DEX1, n =30）, or 1 ug/kg Dexmedetomidine （Group DEX2, n =30）. Mainte- nance of anesthesia was performed using 2MAC end-tidal Sevoflurane. The length of time for the eyes to open and characteristics of emergence in patients were recorded after the anesthesia was discontinued. IRe- suits] The incidence of intraoperative bradycardia in Group DEX2 （26.7%） was significantly higher than in the other groups （3.7% in Group S and 7.4% in Group DEX1）. Six patients （22.2%） in Group S exhibited e- mergence agitation, but it was not observed in any of the patients in the other groups. The length of time for the eyes to open in Group DEX2 was nearly 10 minutes longer than in the other two groups. [Conclusion] We conclude that a single - dose of 0.5 p^g/kg Dexmedetomidine administered after induction of anesthesia re- duces post- Sevoflurane agitation in patients undergoing ECE with no adverse effects.