骨科

文献类型 : 期刊
标题 : Effects of dexmedetomidine on propofol and remifentanil infusion rates during total intravenous anesthesia for spine surgery in adolescents.
摘要 : INTRODUCTION: Total intravenous anesthesia with propofol and a synthetic opioid is a frequently chosen anesthetic technique for posterior spinal fusion. Despite its utility, adverse effects may occur with high or prolonged propofol dosing regimens including delayed awakening. The current study investigated the propofol-sparing effects of the concomitant administration of the alpha(2)-adrenergic agonist, dexmedetomidine, during spinal fusion surgery in adolescents. METHODS: The surgical database of the department of orthopedic surgery was searched and patients (12-21 years of age) were identified who had undergone spinal fusion for either idiopathic or neuromuscular scoliosis during the past 24 months. Patients were assigned to two groups. Group 1 included patients anesthetized with propofol and remifentanil and group 2 included patients anesthetized with dexmedetomidine, propofol, and remifentanil. In the latter group, dexmedetomidine was administered as a continuous infusion of 0.5 microg.kg(-1).h(-1) started after the induction of anesthesia without a loading dose. Propofol was adjusted to maintain the bispectral index (BIS) number at 40-50 and remifentanil was adjusted to maintain the mean arterial pressure (MAP) at 50-65 mmHg. Labetolol or hydralazine was used if the MAP could not be maintained at 50-65 mmHg with remifentanil up to a maximum dose of 0.6 microg/kg/min. Statistical analysis included a nonpaired t-test for parametric data (age, weight, remifentanil/propofol infusion requirements, and heart rate/blood pressure values). A nonparametric statistical analysis (Dunn) was used to compare BIS numbers. Parametric data are presented as the mean +/- SD while nonparametric data are presented as the median and the 95th percentile confidence intervals. RESULTS: Twelve patients received propofol-remifentanil-dexmedetomidine and 24 received propofol-remifentanil. There were no differences in the demographic data, BIS numbers or hemodynamic parameters between the two groups. There was a reduction in the propofol infusion requirements in patients who also received dexmedetomidine (71 +/- 11 microg.kg(-1).min(-1)) compared with those receiving only propofol-remifentanil (101 +/- 33 microg.kg(-1).min(-1), P = 0.0045). No difference was noted in the remifentanil infusion requirements or the use of supplemental agents (hydralazine and labetolol) to maintain controlled hypotension. CONCLUSION: The concomitant use of dexmedetomidine in patients undergoing spinal fusion reduces propofol infusion requirements when compared with those patients receiving only propofol and remifentanil.
页码 : 247-51
作者 : Bagatini A;Volquind D;Rosso A;Trindade RD;Splettstosser JC
作者地址 : CET/SBA, SANE.
摘要 : BACKGROUND AND OBJECTIVES: Scoliosis is a spinal defect very often requiring surgical correction. A uniqueness of this correction is the need for intraoperative emergence and leg movement (wake up test) to rule out central nervous system (CNS) injury after correction of the orthopedic defect. In our report, dexmedetomidine was associated to total intravenous anesthesia with propofol and remifentanil to induce sedation, analgesia and ventilatory stability during wake up test in patient submitted to surgical scoliosis correction. CASE REPORT: Caucasian, female patient, 16 years old, physical status ASA I, with lumbar and thoracic scoliosis in 12 levels, submitted to surgery under general anesthesia. Patient was premedicated with 2 mg oral lorazepam the day before and 90 minutes before surgery. Venoclysis and left arm radial artery puncture were performed after monitoring; right subclavian vein was punctured with double lumen catheter for drug infusion and hemodynamic evaluation. Anesthesia was induced with 1 microg.kg-1 remifentanil and propofol in target-controlled infusion, for 3 microg.mL-1 plasma concentration. Neuromuscular block was achieved with 0.5 mg.kg-1 atracurium. Anesthesia was maintained with 0.4 microg.kg-1.h-1 dexmedetomidine and 0.3 microg.kg-1.min-1 remifentanil in continuous infusion, and 3 microg.mL-1 propofol in target-controlled infusion. At lower limbs movement test, propofol and remifentanil were withdrawn, but dexmedetomidine was maintained. Patient returned to spontaneous ventilation with anesthetic recovery and 14 minutes after drug withdrawal patient has moved lower limbs at verbal command. During this procedure, patient remained in Ramsay's sedation stage 3 that is, under analgesia, spontaneous ventilation and relaxed. CONCLUSIONS: Dexmedetomidine associated to total intravenous anesthesia was an interesting option as adjuvant drug for the wake-up test as well as for perioperative analgesia and sedation. 文献Fra bibliotek型 : 期刊