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Comparison of sedation with dexmedetomidine vs propofol during hysteroscopic surgery: Single‐centre randomized controlled trial
背景与目的
在宫腔镜手术中，用于清醒镇静最合适的镇静药物至今尚未明确。右美托咪啶作为一种镇静和止痛剂，可能适合用于门诊手术。本研究旨在比较右美托咪啶与丙泊酚联合芬太尼、咪达唑仑对短小宫腔镜手术患者镇静、镇痛及血流动力学的影响。
方 法
60例行宫腔镜手术的患者，随机分为右美托咪定组（n = 30）和丙泊酚组(n = 30）。右美托咪定组给予1 µg/kg 的右美托咪定，10 min后以0.7 µg/kg/h 进行维持。丙泊酚组给予1.5 mg/kg负荷剂量的丙泊酚，随后以2.5 mg/kg/h 进行维持。所有患者在宫腔镜手术开始前均给予1.5µg/kg的芬太尼和0.03mg/kg的咪达唑仑。利用VAS对患者疼痛程度进行评估并记录所有患者的血流动力学变化和SAS得分。
结 果
右美托咪定组的平均动脉压(MAP)和心率（HR）明显低于丙泊酚组，然而两组SpO2变化并无显著性差异。此外，右美托咪定组术后的 SAS评分和 VAS 评分明显低于丙泊酚组。所有受试者并未发生心动过缓，低血压及严重的并发症。
结 论
在宫腔镜手术中，右美托咪定镇痛效果优于丙泊酚，并且术后疼痛评分低于丙泊酚。然而，在右美托咪定的使用过程中应密切监测血压及心率的变化。
原始文献摘要
Bingol Tanriverdi T, Koceroglu I, Devrim S,et al.Comparison of sedation with dexmedetomidine vs propofol during hysteroscopic surgery: Single-centre randomized controlled trial[J]. J Clin Pharm Ther 2019 Jan 11; DOI：10.1111/jcpt.12793
What is known and objective: The most appropriate sedative agent for conscious sedation in minor hysteroscopic surgeries is still unclear. Dexmedetomidine a sedative and analgesic agent, may be appropriate for outpatient procedures. The aim of our study was to compare the sedative, analgesic and hemodynamic effects of dexmedetomidine vs propofol in combination with fentanyl and midazolam in patients undergoing minor hysteroscopy surgery.
Methods: Sixty patients undergoing minor hysteroscopic surgery were randomized to receive either dexmedetomidine (n = 30) or propofol (n = 30) groups. Dexmedetomidine was infused at 1 µg/kg for 10 minutes followed by a 0.7 µg/kg/h maintenance infusion. Propofol was infused a bolus of 1.5 mg/kg followed by a 2.5 mg/kg/h maintenance infusion. Fentanyl 1.5µg/kg and midazolam 0.03 mg/kg were performed to all patients as premedication therapy before the hysteroscopic surgery. Post‐operative pain score was assessed with visual analogue scale (VAS).Hemodynamic variables and Riker Sedation‐Agitation Scale (SAS) scores were recorded for all patients.
Results: Mean arterial pressure and heart rate in the dexmedetomidine group were significantly lower than in propofol group, whereas SpO2 was similar between two groups. In addition, post‐operative Riker SAS and VAS scores were significantly lower in dexmedetomidine group than in the propofol group. Bradycardia, hypotension and serious adverse events did not occur in any patients.
What is new and conclusion: Dexmedetomidine was associated with better analgesia and lower post‐operative pain score than propofol in patients undergoing hysteroscopic surgery. However, arterial pressure and heart rate should be more closely monitored in patients received dexmedetomidine.
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