小儿术前用药采用右美托咪定复合氯胺酮滴鼻

Premedication with intranasal dexmedetomidine combined with ketamine in children

目的:比较小儿术前右美托咪定单独应用及与氯胺酮复合应用的效果与安全性。方法:择期行静脉畸形硬化剂治疗手术患儿100例,年龄1~5岁,美国麻醉医师协会分级Ⅰ~Ⅱ级,分成:研究组(右美托咪定2μg/kg滴鼻+氯胺酮1 mg/kg滴鼻)(n=50),对照组(右美托咪定2μg/kg滴鼻)(n=50)。患儿术前30 min在麻醉准备室接受用药,记录滴鼻前(T0)及给药后10 min(T1)、20 min(T2)、30 min(T3)患儿的心率(heart rate,HR)、氧饱和度(percutaneous oxygen saturation,SpO2),T3时用镇静评分表(modified observer’s assessment of alertness/sedation scale,MOAA/S)行镇静评分。用父母分离焦虑量表(parental separation anxiety scale,PSAS)行焦虑状态评分。记录入睡时间和术中是否发生低血压、心动过缓,术后苏醒时间等。结果:研究组MOAA/S评分明显优于对照组(P<0.05)。两组间PSAS评分差异有统计学意义(P<0.05)。对照组在T3时HR下降较研究组明显(P<0.05),其余时间点HR和SpO2在两组间无明显差异。研究组患儿入睡时间明显短于对照组,苏醒时间长于对照组,差异有统计学意义(P<0.05)。两组均未见明显低血压、心动过缓事件。结论:右美托咪定复合氯胺酮滴鼻镇静起效快、效果好,使患儿安静地与父母分离,是一种安全简便的小儿术前用药方法。

Objective To evaluate the effect and security of premedication with intranasal dexmedetomidine combined with ketamine in children. Methods A total of 100 children received sclerotherapy on venous malformations, aged1-5 years, American Society of Anesthesiologists Ⅰ-Ⅱ, were enrolled in this study. Fifty children were given intranasal dexmedetomidine at 2 μg/kg in one nostril and intranasal ketamine of 1 mg/kg in the other nostril as study group, and50 children were given only dexmedetomidine at 2 μg/kg as control group. Premedication was performed at 30 min before operation. Heart rate(HR) and percutaneous oxygen saturation(SpO2) were recorded before premedication and 10 min(T1), 20 min(T2) and 30 min(T3) after premedication. When T3 after premedication modified observer ’s assessment of alertness/sedation scale(MOAA/S) was assessed for children, sedation state. Parental separation anxiety scale(PSAS) was assessed for children emotional state. Sleep latency and wake-up time were recorded with intraoperative hypotension and bradycardia. Results The sedation assessed by the MOAA/S(≤3 points) in study group was significantly better than that in control group with statistical differences(P<0.05). There was significant difference in PSAS scale between 2 groups(P<0.05). There was no significant difference in HR and SpO2 except for the decrease in HR at T3 of control group(P<0.05).The sleep latency was shorter and wake-up time was longer in study group when compared with those in control group(P<0.05). There was no obvious hypotension and bradycardia in both groups. Conclusions Intranasal dexmedetomidine combined with ketamine would be a safe and simple premedication in children, which could sedate children well.