右美托咪啶对脑电双频指数引导的闭环回路麻醉输注系统麻醉期间异丙酚用量的影响：一项随机对照研究
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
The Effect of Dexmedetomidine on Propofol Requirements During Anesthesia Administered by Bispectral Index-Guided Closed-Loop Anesthesia Delivery System: A Randomized Controlled Study
背景与目的
右美托咪啶是一种选择性的α2-肾上腺素能激动剂，目前已批准用于重症监护病房持续镇静，正广泛评估它作为一种潜在麻醉剂的作用。闭环回路麻醉输注系统(CLADS)是一种利用脑电双频指数(BIS)反馈自动实施异丙酚全凭静脉麻醉并获得更高一致性的全身麻醉(GA)稳定状态的方法。这项研究评估右美托咪啶在CLADS实施的全凭静脉麻醉中是否能有效的进一步降低异丙酚的需求。
方 法
在获得伦理委员会批准和书面知情同意后，80名进行腹腔镜/机器人择期手术的患者随机分为两组，接受加或不加右美托咪啶的异丙酚GA。分析异丙酚的定量减少和麻醉深度的质量(主要结果)，术中血流动力学，术后不良事件(镇静，镇痛，恶心和呕吐)的发生率，以及术中意识回忆(次要结果)。
结 果
右美托咪啶组麻醉诱导时异丙酚需要量显著降低(15%)(右美托咪啶组：平均±标准差0.91±0.2 6 mg/kg；非右美托咪啶组：1.0 7±0.2 3 mg/kg，平均差值：0.163，95%CI，0.0 4~0.2 8)；P=.01)，维持GA(右美托咪啶组：3.25±0.97 mg/kg/h；非右美托咪啶组：4.57±1.21 mg/kg/h，平均差值：1.32，95%CI，0.78~1.85；P<.001)。作为偏倚衡量标准的BIS对照的偏离度在右美托咪啶组(1%[−5.8%，8%])明显低于非右美托咪定组(8%[2%，12%]；P=.002)。麻醉深度一致性参数，包括在靶点±10范围内的BIS时间百分比没有差异(右美托咪啶组：79.5[72.5，85.3]；非右美托咪啶组：81[68，88]；P=.534)，准确度(右美托咪啶组：12%[10%，14%])没有发现差异；非右旋美托咪啶组：12%[10%，14%]；P=.777)，摆动度(右美托咪啶组：10%[8%，10%]；非右旋美托咪啶组：8%[6%，10%]；P=.080)，总分(右美托咪定组：25.2[23.1，35.8])；非右旋美托咪啶组：24.7[20，38.1]；P=.387)。同样，两组间术中心率和平均动脉压的时间百分比在基线20%以内无明显差异。然而，在丙泊酚中加入右美托咪啶明显的增加了心动过缓的发生率(右美托咪胺组：14[41.1%]；非右美托咪啶组：3[9.1%]；P=.004)，低血压的发生率(右美托咪啶组：9[26.5%]；非右美托咪胺组：2[6.1%]；P=0.045)，以及术后早期镇静。
结 论
CLADS给药时在异丙酚中加入右美托咪定在麻醉深度一致的情况下能显著降低异丙酚的用量，但会出现血流动力学抑制和术后早期镇静。
原始文献摘要
Amitabh Dutta, Nitin Sethi, Jayashree Sood,et al.The Effect of Dexmedetomidine on Propofol Requirements During Anesthesia Administered by Bispectral Index-Guided Closed-Loop Anesthesia Delivery System: A Randomized Controlled Study[J].Anesth Analg 2019;129:84–91
BACKGROUND: Dexmedetomidine, a selective α2-adrenergic agonist currently approved for continuous intensive care unit sedation, is being widely evaluated for its role as a potential anesthetic. The closed-loop anesthesia delivery system (CLADS) is a method to automatically administer propofol total intravenous anesthesia using bi-spectral index (BIS) feedback and attain general anesthesia (GA) steady state with greater consistency. This study assessed whether dexmedetomidine is effective in further lowering the propofol requirements for total intravenous anesthesia facilitated by CLADS.
METHODS: After ethics committee approval and written informed consent, 80 patients undergoing elective major laparoscopic/robotic surgery were randomly allocated to receive GA with propofol CLADS with or without the addition of dexmedetomidine. Quantitative reduction of propofol and quality of depth-of-anesthesia (primary objectives), intraoperative hemodynamics, incidence of postoperative adverse events (sedation, analgesia, nausea, and vomiting), and intraoperative awareness recall (secondary objectives) were analyzed.
RESULTS: There was a statistically significant lowering of propofol requirement (by 15%) in the dexmedetomidine group for induction of anesthesia (dexmedetomidine group: mean ± standard deviation 0.91 ± 0.26 mg/kg; nondexmedetomidine group: 1.07 ± 0.23 mg/kg, mean difference: 0.163, 95% CI, 0.04–0.28; P = .01) and maintenance of GA (dexmedetomidine group: 3.25 ± 0.97 mg/kg/h; nondexmedetomidine group: 4.57 ± 1.21 mg/kg/h, mean difference: 1.32, 95% CI, 0.78–1.85; P < .001). The median performance error of BIS control, a measure of bias, was significantly lower in dexmedetomidine group (1% [−5.8%, 8%]) versus nondexmedetomidine group (8% [2%, 12%]; P = .002). No difference was found for anesthesia depth consistency parameters, including percentage of time BIS within ±10 of target (dexmedetomidine group: 79.5 [72.5, 85.3]; nondexmedetomidine group: 81 [68, 88]; P = .534), median absolute performance error (dexmedetomidine group: 12% [10%, 14%]; nondexmedetomidine group: 12% [10%, 14%]; P = .777), wobble (dexmedetomidine group: 10% [8%, 10%]; nondexmedetomidine group: 8% [6%, 10%]; P = .080), and global score (dexmedetomidine group: 25.2 [23.1, 35.8]; nondexmedetomidine group: 24.7 [20, 38.1]; P = .387).Similarly, there was no difference between the groups for percentage of time intraoperative heart rate and mean arterial pressure remained within 20% of baseline. However, addition of dexmedetomidine to CLADS propofol increased the incidence of significant bradycardia (dexmedetomidine group: 14 [41.1%]; nondexmedetomidine group: 3 [9.1%]; P = .004), hypotension (dexmedetomidine group: 9 [26.5%]; nondexmedetomidine group: 2 [6.1%]; P = .045), and early postoperative sedation.
CONCLUSIONS: The addition of dexmedetomidine to propofol administered by CLADS was associated with a consistent depth of anesthesia along with a significant decrease in propofol requirements, albeit with an incidence of hemodynamic depression and early postoperative sedation.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：余晓旭 编辑：何幼芹 审校：王贵龙