右美托咪定静脉负荷用药或负荷加维持用药用于重比重布比卡因腰麻的效果
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Effect of intravenous dexmedetomidine administered as bolus or as bolus-plus-infusion on subarachnoid anesthesia with hyperbaric bupivacaine
背景与目的：蛛网膜下腔麻醉是一种广泛应用于脐以下手术的区域麻醉阻滞技术。目前认为蛛网膜下腔麻醉加静脉用右美托咪定同时延长感觉和运动阻滞。
1
方法：将拟在蛛网膜下腔麻醉下行择期脐下手术的75例患者随机分为三组。B组静脉泵注生理盐水10 min以上，然后鞘内注射布比卡因12.5 mg，并且继续泵注生理盐水60 min。BdexB组（布比卡因+右美负荷量组）静脉泵注右美（(1 μg/kg）10 min以上，然后鞘内注射布比卡因12.5 mg，并且继续泵注生理盐水60 min。BdexBI组（布比卡因+右美负荷量组）静脉泵注右美（0.5 μg/kg）10 min以上，然后鞘内注射布比卡因12.5 mg，并且继续泵注右美（0.5 μg/kg）60 min。分别记录镇痛起效(T10水平)、完全运动阻滞(Bromage分值3)及镇痛水平最高时间。定期检查感觉和运动水平，直至感觉恢复（S2-S4处）及运动恢复（Bro法师评分0）。同时记录Ramsay镇静评分和心动过缓/低血压发生率。
结果：BdexB组(303 Min)和BdexBI组(288 Min)的感觉恢复时间明显长于B组(219.6 min)。BdexB组(321.6 min)和BdexBI组(302.4 min)的运动恢复时间较B组(233.4 min)明显延长。接受右美托咪定处理的病人均处于镇静状态，但很容易被唤醒。
结论：右美托咪定静脉负荷用药或负荷加维持用药用于重比重布比卡因腰麻使感觉和运动阻滞均延长。
Kavya UR, Laxmi S, Ramkumar V.
Effect of intravenous dexmedetomidine administered as bolus or as bolus-plus-infusion on subarachnoid anesthesia with hyperbaric bupivacaine
J Anaesthesiol Clin Pharmacol. 2018 Jan-Mar;34(1):46-50. doi: 10.4103/joacp.JOACP_132_16.
BACKGROUND:Subarachnoid anesthesia is a widely practiced regional anesthetic for infraumbilical surgeries. Intravenous dexmedetomidine is known to prolong both sensory and motor blockade when administered along with subarachnoid anesthesia.
METHODS:Seventy-five patients scheduled to undergo elective infraumbilical surgeries under subarachnoid anesthesia were randomly allocated to one of the three groups. Group B received intravenous saline over 10 min followed by 12.5 mg intrathecal bupivacaine and then intravenous saline over 60 min. Group bupivacaine + dexmedetomidine bolus (BDexB) received intravenous dexmedetomidine (1 μg/kg) over 10 min followed by 12.5 mg intrathecal bupivacaine and then intravenous saline over 60 min. Group bupivacaine + dexmedetomidine bolus-plus-infusion (BDexBI) received intravenous dexmedetomidine (0.5 μg/kg) over 10 min followed by 12.5 mg intrathecal bupivacaine and then intravenous dexmedetomidine (0.5 μg/kg) over 60 min. Onset of analgesia (at T10), complete motor block (Bromage score 3), and highest level of analgesia were noted. Sensory and motor levels were checked periodically till sensory recovery (at S2-S4) and complete motor recovery (Bromage score 0). Ramsay sedation score and incidence of bradycardia/hypotension were noted.
RESULTS:Sensory recovery was significantly longer in Group BDexB (303 min) and Group BdexBI (288 min) as compared to Group B (219.6 min). Motor recovery was also significantly prolonged in Group BDexB (321.6 min) and Group BDexBI (302.4 min) as compared to Group B (233.4 min). Patients receiving dexmedetomidine were sedated but were easily arousable.
CONCLUSIONS:Intravenous dexmedetomidine given as bolus or bolus-plus-infusion with intrathecal hyperbaric bupivacaine prolongs both sensory and motor blockade.
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