右美托咪定滴鼻预处理对单眼眼底检查小儿全身麻醉效果和安全性的影响

Influence of intranasal dexmedetomidine premedication on general anesthesia effect and safety in pediatric patients undergoing monocular fundus examination

目的:观察右美托咪定滴鼻预处理对首次接受单眼眼底检查小儿全身麻醉效果和安全性的影响。方法:2018年10月至2019年4月首都医科大学附属北京同仁医院首次全身麻醉下行单眼眼底检查的视网膜母细胞瘤(RB)患儿纳入本研究,采用随机数字表法将其分为右美托咪定组和对照组,每组30例。入手术室前,右美托咪定组患儿经鼻滴入右美托咪定2 μg/kg,对照组患儿经鼻滴入0.9%氯化钠注射液0.02 ml/kg。经鼻给药30 min后患儿转入手术室,监测并记录心率和脉搏血氧饱和度(SpO 2),2组患儿均经面罩吸入8%七氟烷诱导麻醉后置入喉罩,吸入2%~3%七氟烷维持麻醉,术中保留自主呼吸。比较2组患儿滴鼻前(T 0)、滴鼻后30 min(T 1)、喉罩置入时(T 2)、手术开始时(T 3)及拔除喉罩时(T 4)的心率和SpO 2及麻醉后恢复室(PACU)停留时间,采用分离焦虑量表(PSAS)评估入手术室时患儿与家长的分离状况,采用小儿苏醒期躁动量表(PAED)评价患儿在PACU期间意识恢复时的躁动程度,采用Ramsay镇静评分评价患儿在PACU意识恢复时的镇静程度。 结果:2组患儿的一般情况、不同时间点SpO 2、在PACU停留时间的差异均无统计学意义(均 P>0.05)。除T 0外,右美托咪定组患儿T 1~T 4时间点的心率均低于对照组,差异均有统计学意义(均 P<0.05);右美托咪定组患儿较对照组患儿更容易与家长分离,PSAS评分低于与对照组[(2.40±0.81)比(2.93±0.87), P=0.018];苏醒期躁动发生率低于对照组[(16.7%,5/30)比(63.3%,19/30), P<0.001];Ramsay评分高于对照组[(3.2±0.7)比(1.9±0.6), P<0.001];PAED评分低于对照组[6(2,12)比12(5,8), P<0.001]。 结论:全麻下首次行眼底检查或手术的单眼RB患儿接受右美托咪定滴鼻预处理可降低入手术室时与家长分离的焦虑程度和全麻后苏醒期躁动发生率,且未延长在PACU的停留时间。提示右美托咪定滴鼻预处理在小儿眼科日间超短手术全身麻醉中的辅助作用有效且安全。

Objective To observe the influence of intranasal dexmedetomidine premedication on general anesthesia effect and safety in pediatric patients undergoing monocular fundus examination for the first time.Methods Pediatric patients with monocular retinoblastoma(RB)who underwent fundus examination under the general anesthesia for the first time in Beijing Tongren Hospital,Capital Medical University from October 2018 to April 2019 were divided into the dexmedetomidine group and the control group by random number table method,each group comprised 30 cases.Before entering the operating room,the children in the dexmedetomidine group received intranasal dexmedetomidine 2μg/kg and 0.9%sodium chloride injection 0.02 ml/kg in the control group,respectively.Thirty minutes later,the children were transferred to the operation room.Their heart rate and pulse oximetry saturation(SpO2)were monitored and recorded.The children in the 2 groups were anesthetized with 8%sevoflurane inhaled through a mask and then placed into a laryngeal mask for maintenance anesthesia by inhaling 2%-3%sevoflurane.Spontaneous breathing was retained during the operation.The heart rate and SpO2 before nasal administration drip(T0),30 minutes after nasal drip(T1),at the time of laryngeal mask placement(T2),at the beginning of operation(T3),and at the time of laryngeal mask removal(T4)and retention time in post anesthesia care unit(PACU)were compared between the patients in the 2 groups.The children′s separation status from parents when entering the operation room were evaluated by the Parental Separation Anxiety Scale(PSAS),the emergence agitation degree in PACU were evaluated by the Pediatric Anesthesia Emergence Delirium(PAED)scale,and the level of sedation of children at consciousness recovery in PACU were evaluated by Ramsay score.Results The differences of children′s general condition,SpO2 at different time points,and the retention time in PACU between the 2 groups were not statistically significant(P>0.05 for all).Except T0,the heart rates at time points of T1-T4 in the dexmedetomidine group were lower than those in the control group,and the differences were statistically significant(P<0.05 for all).Compared with those in the control group,the children in the dexmedetomidine group were more easily separated from their parents when entering the operation room;the PSAS score was lower[(2.40±0.81)vs.(2.93±0.87),P=0.018];the incidence of restlessness during the consciousness recovery period was lower[(16.7%,5/30)vs.(63.3%,19/30),P<0.001];Ramsay score was higher[(3.2±0.7)vs.(1.9±0.6),P<0.001];and PAED score was lower[6(2,12)vs.12(5,8),P<0.001].Conclusions Intranasal dexmedetomidine premedication can reduce children′s anxiety degree of separation from parents when entering the operation room and the incidence of emergence agitation during recovery period after general anesthesia,and did not prolong the retention time in PACU.It is suggested that intranasal dexmedetomidine premedication is effective and safe in general anesthesia for ultra-short daytime ophthalmological ambulatory surgery in children.