异丙酚或右美托咪定与七氟醚在小儿骨髓穿刺麻醉中的比较

H. ElHoshy, A. Khalifa
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摘要

虽然儿童骨髓抽吸(BMA)是一种常见的短期手术,但近65%的患者会出现严重的焦虑,这种焦虑可能会持续更长时间,直至慢性术后行为改变。因此,任何相关麻醉技术的目标都是提供平稳的非创伤性诱导,安全维持和快速恢复。本研究的目的是评估使用异丙酚或右美托咪定与七氟醚进行全静脉麻醉(TIVA)对计划行BMA的儿童维持麻醉的效果。患者和方法选择60名年龄在3-12岁,符合美国麻醉医师学会身体状态I和II的计划行选择性BMA和活检的儿童,随机分为三组(每组20名),分别接受七氟烷吸入麻醉诱导,七氟烷和芬太尼输注维持(S组)。术后输注异丙酚芬太尼维持麻醉(P组)或输注右美托咪定诱导,再输注右美托咪定芬太尼维持麻醉(D组)。主要终点为手术后到达术后护理单位时的镇静评分。次要结局包括手术时间、血流动力学变量、父母和外科医生的满意度以及任何不良事件的发生率。结果血流动力学显示,与术前基线水平相比,三个研究组的血流动力学指标有统计学意义上的显著下降。D组血氧饱和度明显高于P组,P组自发睁眼时间明显短于其他两组(P<0.001)。D组的成员相对于其他两组更镇静。D组患儿家长满意度和手术满意度均高于其他两组(P<0.05)。结论右美托咪定对BMA患儿有良好的血流动力学稳定性和平稳的恢复,是维持麻醉的一种较好的选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison between total intravenous anesthesia using propofol or dexmedetomidine versus sevoflurane during anesthesia of children undergoing bone marrow aspiration
Background Although bone marrow aspiration (BMA) in children is a familiar short duration procedure, nearly 65% of patients develop sever anxiety that may extend more beyond, up to chronic postoperative behavioral changes. Consequently, the objectives of any related anesthetic technique is to afford smooth nontraumatic induction with safe maintenance and rapid recovery. The rational of the current study is to assess the outcomes of total intravenous anesthesia (TIVA) using propofol or dexmedetomidine versus sevoflurane for maintenance of anesthesia in children scheduled for BMA. Patients and methods A total of 60 children aged 3–12 years of American Society of Anesthesiologists physical status I and II, who planned to undergo elective BMA and biopsy were enrolled randomly to one of three groups (20 child each) receiving either sevoflurane inhalational anesthesia for induction, then sevoflurane and fentanyl infusion for maintenance (group S), propofol infusion for induction afterward propofol and fentanyl infusions for maintenance of anesthesia (group P) or dexmedetomidine infusion for induction after that dexmedetomidine and fentanyl infusions for maintenance (group D). The primary endpoint was postoperative sedation score on arriving the postanesthetic care unit after the procedure. Secondary outcomes included procedure duration, hemodynamic variables, parents and surgeons satisfaction and incidences of any adverse events. Results Hemodynamics revealed statistically comparable significant decrease in the three studied groups relative to the preoperative baseline levels. Values of oxygen saturation in group D showed significant increase relative to those of group P. Time for spontaneous eye open were significantly shorter in group P comparable to the other two groups (P<0.001). Members of group D were more sedated relative to the other two groups. Satisfaction of both parents and surgeons were significantly higher in the group D relative to the other two studied groups (P<0.05). Conclusion TIVA with dexmedetomidine can be a superior alternative to TIVA with propofol or sevoflurane for maintenance of anesthesia in children scheduled for BMA in consequence of favorable hemodynamic stability and smooth recovery profile.
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