Objective To evaluate the effects and safety of dezocine and dexmedetomidine hydrochloride on the prevention of the pediatric postoperative agitation. Methods A total of 90 pediatric patients undergoing prepuce cerclage were randomly divided into 3 groups(n=30):dezocine group( Group Dez ),dexmedetomidine group( Group Dex ) and control group( Group C ),all groups were implemented general anesthesia combining with penile dorsal nerve block anesthesia.After induction of anesthesia,Group Dez and Group Dex were given 0.1 mg·kg-1 of dezocine and 0.5 μg·kg-1 of dexmedetomidine hydrochloride,respectively,Group C was given 0.9% sodium chloride solution.The rate of pediatric agitation, the operating room,the recovery time,the amount of additional propofol during the operation and the adverse reaction incidence within 6 hours after the surgery(circulation and respiratory depression,drowsiness,headache,nausea and vomiting) were observed and recorded . Results All groups have the surgery successfully done.There were no significantly difference among the three groups on the recovery time( P>0.05) .The incidence of postoperative agitation was 3.33% in Group Dez,0.00% in Group Dex,46.67% in Group C ,respectively( P<0.05 ) .All of the pediatrics in three groups were not given additional propofol.There was no obvious adverse reaction at the time of 6 hours after surgery. Conclusion Dezocine and dexmedetomidine hydrochloride both can reduce the rate of postoperative agitation in pediatric patients and have no obvious side effects.Therefore,the clinical use of dezocine and dexmedetomidine hydrochloride are safe and effective.
选择在小儿外科手术室全身麻醉联合阴茎背神经阻滞麻醉下择期行包皮套扎术患儿90例,按照美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级为Ⅰ或Ⅱ级,年龄3~6岁。排除困难气道、手术复杂、体质量超出标准体质量±20%及严重心肺等并发症患儿。本研究通过本院伦理委员会批准,患儿家属同意并签署知情同意书。
LI BL,YUEN VM,SONG XR,et al.Intranasal dexmede-tomidine following failed chloral hydrate sedation in children[J].,2014,69(3):240-244.
Chloral hydrate is the most commonly used sedative for paediatric diagnostic procedures in China with a success rate of around 80%. Intranasal dexmedetomidine is used for rescue sedation in our centre. This prospective investigation evaluated 213 children aged onemonth to 10years who were not adequately sedated following administration of chloral hydrate. Children were randomly assigned to receive rescue intranasal dexmedetomidine at 1 g.kg(-1) (group 1), 1.5 g.kg(-1) (group 2) or 2 g.kg(-1) (group 3). The sedation level was assessed every 10min using a modified observer's assessment of alertness/sedation scale. Successful rescue sedation in groups 1, 2 and 3 were 56 (83.6%), 66 (89.2%) and 51 (96.2%), respectively. Increasing the rescue dose was associated with an increased success rate with an odds ratio of 4.12 (95% CI 1.13-14.98), p=0.032. We conclude that intranasal dexmedetomidine is effective for sedation in children who do not respond to chloral hydrate.
ERQILJ,KAVAK AF,QZKAND,et al.Effects of pre-treatment with esmolol and lidocaine on injection pain and rocuronium-induced withdrawal response[J].,2015,45(4):959-963.
We aimed to compare the effectiveness of esmolol 1 mg/kg and lidocaine 1 mg/kg for injection pain and for the prevention of rocuronium-induced withdrawal response.We enrolled a total of 81 patients in the study. Patients were randomly assigned to receive either 10 mL of 0.9% NaCl (Group P), esmolol 1 mg/kg (Group E), or lidocaine 1.0 mg/kg (Group L). A subparalyzing dose of rocuronium 0.05 mg/ kg was administered to all patients and its effects were recorded. Anesthesia was induced with intravenous propofol and intravenous rocuronium 0.5 mg/kg in all groups. The withdrawal movements of the patient groups were subsequently graded.There was a statistically significant difference in overall incidence of pain in group E and L compared to the placebo group after administrating the subparalyzed dose (no pain response: Group E = 81.5%, Group L = 77.8%, Group P = 14.8%) (P < 0.001). After intravenous administration of an intubating dose of rocuronium, the esmolol group had a significantly lower incidence of withdrawal movement than the other groups (no response: Group E = 81.5%, Group L = 63%, Group P = 22.2%) (P < 0.001).We found that esmolol significantly attenuates rocuronium-induced withdrawal movement and also reduces pain when used at subparalyzing doses.
ALIPOURM,TABARIM,ALIPOURM.Paracetamol,ond-ansetron,granisetron,magnesium sulfate and lidocaine and reduced propofol injection pain[J].,2014,16(3):e16086.
Paracetamol, Ondansetron, Granisetron, Magnesium Sulfate and Lidocaine and Reduced Propofol Injection Pain - Iranian Red Crescent Medical Journal - - Kowsar
GALGON RE,STRUBEP,HEIERJ,et al.Magnesium sulfate with lidocaine for preventing propofol injection pain:a randomized,double-blind,placebo-controlled trial[J].,2015,29(2):206-211.
Propofol injection pain, despite various strategies, remains common and troublesome. This study aimed to test the hypothesis that pretreatment with the combination of intravenous lidocaine and magnesium would have an additive effect on reducing propofol injection pain.After institutional review board (IRB) approval and informed consent, we performed a prospective, double-blind, placebo-controlled, randomized trial. Subjects were randomly assigned to pretreatment with either lidocaine (5002mg), magnesium sulfate (0.2502mg), lidocaine (5002mg) plus magnesium sulfate (0.2502mg), or 0.902% sodium chloride. Following pretreatment, propofol (5002mg) was administered, and subjects were questioned regarding injection site pain and observed for behavioral signs of pain.Two hundred subjects were enrolled and 158 subjects (39 placebo, 38 lidocaine, 44 magnesium sulfate, and 37 lidocaine plus magnesium sulfate) received their assigned pretreatment intervention. Intergroup baseline characteristics were similar. The proportion of subjects reporting propofol injection pain was highest in those pretreated with magnesium sulfate (5702%), followed by those pretreated with placebo (4602%), lidocaine plus magnesium sulfate (4102%), and then lidocaine (2902%; p02=020.011). When adjusted for age, gender, diabetes mellitus, chronic pain, tobacco use, and selective-serotonin reuptake inhibitor use, the pain response scale scores were significantly reduced by lidocaine pretreatment compared to magnesium sulfate and placebo (p02=020.031 and p02=020.0003, respectively).In this double-blind, placebo-controlled, randomized trial, the combination of intravenous magnesium sulfate and lidocaine offered no additional benefit for the relief of propofol injection pain compared to intravenous lidocaine alone. An improved, receptor-based understanding of the mechanism of propofol injection pain is still needed.
ZHANGL,ZHUJ,XUL,et al.Efficacy and safety of flur-biprofen axetil in the prevention of pain on propofol injection:a systematic review and meta-analysis[J].,2014,20(17):995-1002.
Pain on injection is an acknowledged adverse effect (AE) of propofol administration for the induction of general anesthesia. Flurbiprofen axetil has been reported to reduce the pain of injection. However, results of published papers on the efficacy of flurbiprofen axetil in managing pain on injection of propofol are inconsistent. We conducted a comprehensive meta-analysis of studies to appraise the efficacy and safety of flurbiprofen axetil for controlling pain induced by propofol injection. The pooled risk ratio (RR) with corresponding 95% confidence intervals (CI) was calculated employing fixed- or random-effects models, depending upon the heterogeneity of the included trials. Compared with the placebo group, flurbiprofen axetil allows more patients to have no pain (RR 3.51, 95% CI 2.22-5.55, p=0.000), and decreases the cumulative number of patients with mild, moderate, and severe pain on injecting propofol (RR 0.70, 95% CI 0.58-0.86, p=0.000; RR 0.59, 95% CI 0.46-0.75, p=0.000; RR 0.25, 95% CI 0.16-0.38, p=0.000, respectively). In the stratified analysis by the doses, flurbiprofen axetil at a dose of over 50 mg was found to be effective in reducing propofol-induced pain on injection; however, there were no significant differences in relieving pain between treatment and placebo groups with flurbiprofen axetil at a dose of 25 mg. In terms of drug safety, there were no adverse effects (AEs) reported between flurbiprofen axetil-based regimens and placebo regimens. Flurbiprofen axetil, an injectable prodrug of flurbiprofen, can significantly prevent or relieve the pain induced by propofol injection. More studies are required to assess its adverse effects.
ATASHKHOYIS,NEGARGARS,HATAMI-MARANDIP.Effects of the addition of low-dose ketamine to propofol-fentanyl anaesthesia during diagnostic gynaecological laparoscopy[J].,2013,170(1):247-250.
Diagnostic gynaecological laparoscopy (DGL) is a brief procedure, generally performed on an outpatient basis. Propofol-fentanyl is often used for anaesthesia in minor outpatient procedures because of its rapid onset, short duration of action and smooth patient awakening. However, propofol has various cardiovascular effects such as reduced arterial pressure, cardiac output and cardiac index. Ketamine is an intravenous anaesthetic and short-acting analgesic that could alleviate the haemodynamic effects of propofol due to its sympathomimetic activity. The aim of this placebo-controlled trial was to evaluate the effects of the addition of low-dose ketamine to propofol-fentanyl anaesthesia in DGL.In this double-blind randomized trial, 60 healthy women undergoing gynaecological laparoscopy to investigate infertility were studied. Following injection of midazolam and fentanyl in all patients, the study group (n=30) received ketamine 0.5 mg/kg and propofol 1-2.5 mg/kg, and the placebo group (n=30) received saline 0.9% and propofol 1-2.5 mg/kg. Propofol was subsequently infused for the maintenance of anaesthesia.Patients in the study group had a significantly lower incidence of pain than patients in the placebo group during propofol injection (13% vs 87%, respectively; p<0.0001). After induction of anaesthesia, 16 (53%) patients in the placebo group and three (10%) patients in the study group had a decreased heart rate (p<0.001). The decrease in mean arterial pressure was greater in the placebo group compared with the study group (37% vs 7%, respectively; p<0.001). During the procedure, the total mean standard deviation dose of propofol was 420卤65 mg in the placebo group and 330卤35 mg in the study group (p<0.001). Pain scores for the first 3h after the operation were significantly lower in the study group (p<0.001).Use of low-dose ketamine with propofol-fentanyl anaesthesia in patients undergoing DGL was associated with less pain during propofol injection, lower incidence of haemodynamic changes, lower total dose of propofol and improved postoperative analgesia.
THESBJERG SE,HARBOE KM,BARDRAML,et al.Sex differences in laparoscopic cholecystectomy[J].,2010,24(12):3068-3072.
Background Conversion from laparoscopic to open cholecystectomy may not be desirable due to the increased complication rate and prolonged convalescence. In Denmark, nationwide data show that 7.7% of the laparoscopic cholecystectomies are converted to open surgery. This article aims to document the relationship of gender to conversion rate and length of hospital stay after laparoscopic cholecystectomy in a national cohort of patients. Methods The gender of 5,951 patients from the 2007 National Danish Cholecystectomy Database was compared with conversion rate, length of hospital stay, and various risk factors using multivariate analyses. Results The findings showed that 14.3% of the patients had acute cholecystitis and that men had the highest risk (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.66–2.27). The operative findings for the men included sequelae from previous acute cholecystitis more frequently than the findings for the women (OR, 1.89; 95% CI, 1.67–2.15). The rate for conversion from laparoscopic to open surgery was 7.7%, and male sex was highly associated with conversion (OR, 2.48; 95% CI, 2.04–3.01). Thus, 259 (5.8%) of the 4,451 operations for women were converted to laparotomy compared with 199 (13.3%) of the 1,500 operations for men. No significant sex differences were found in the proportion of bile duct lesions (those requiring reconstructive surgery as well as those that could be handled by endoscopy or T-tube drainage, suturing, or both) or in the 30-day mortality rate. The multivariate analyses showed that male sex was a significant factor for conversion but not for length of postoperative stay or readmission. Conclusion Men showed a significantly higher risk of the operation being converted from laparoscopic to open cholecystectomy than women (OR, 2.48; 95% CI, 2.04–3.01). The main reason for this may be that men more frequently had acute cholecystitis or sequelae from previous acute cholecystitis. These results can be used to give patients a better basis for their informed consent and better resource management in connection with the operation.
ZHU YM,JING GX,YUANW.Preoperative administra-tion of intramuscular dezocine reduces postoperative pain for laparoscopic cholecystectomy[J].,2011,25(5):356-361.
Postoperative pain is the most common complaint after laparoscopic cholecystectomy.This study was carried out to evaluate whether preoperative administration of intramuscular dezocine can provide postoperative analgesia and reduce postoperative opioid consumption in patients undergoing laparoscopic cholecystectomy.Patients (ASA or ) scheduled for laparoscopic cholecystectomy were randomly assigned into intramuscular dezocine group (group 1) or intramuscular normal saline group (group 2).Dezocine and equal volume normal saline were administered intramuscularly 10 min before the induction of anesthesia.After operation,the severity of postoperative pain,postoperative fentanyl requirement,incidence and severity of side-effects were assessed.Postoperative pain and postoperative patient-controlled fentanyl consumption were reduced significantly in group 1 compared with group 2.The incidence and severity of side effects were similar between the two groups.Preoperative single-dose administration of intramuscular dezocine 0.1 mg/kg was effective in reducing postoperative pain and postoperative patient-controlled fentanyl requirement in patients undergoing laparoscopic cholecystectomy.
YUEN VM,HUI TW,IRWIN MG,et al.A randomised comparison of two intranasal dexmedetomidine doses for premedication in children[J].,2012,67(11):1210-1216.
Abstract We compared sedation levels in children following administration of intranasal dexmedetomidine. One hundred and sixteen children aged between 1 and 8 years were enrolled in this prospective, randomised trial. Children were assigned to receive either intranasal dexmedetomidine 1 0204g.kg(-1) (Group 1) or 2 0204g.kg(-1) (Group 2). Thirty-one (53%) patients from Group 1 and 38 (66%) patients from Group 2 were satisfactorily sedated at the time of anaesthetic induction. Logistic regression showed a significant interaction effect (p=0.049), with the odds ratio between Group 2 over Group 1 estimated as 1.1 (95% CI 0.5-2.7) for the 1-4 year age group, and 10.5 (95% CI 1.4-80.2) for the 5-8 year age group. Both doses produced a similar level of satisfactory sedation in children aged 1-4 years, whereas 2 0204g.kg(-1) resulted in a higher proportion of satisfactory sedation in children aged 5-8 years. There were no adverse haemodynamic effects. We conclude that intranasal dexmedetomidine in a premedication dose of 2 0204g.kg(-1) resulted in excellent sedation in children. Anaesthesia 0008 2012 The Association of Anaesthetists of Great Britain and Ireland.
MEKITARIAN FE,ROBINSONF, DE CARVALHO W B, et al.Intranasal dexmedetomidine for sedation for pediatric computed tomography imaging[J].,2015,166(5):1313-1315.
Abstract This prospective observational pilot study evaluated the aerosolized intranasal route for dexmedetomidine as a safe, effective, and efficient option for infant and pediatric sedation for computed tomography imaging. The mean time to sedation was 13.402minutes, with excellent image quality, no failed sedations, or significant adverse events. TRIAL REGISTRATION: Registered with ClinicalTrials.gov: NCT01900405. Copyright 08 2015 Elsevier Inc. All rights reserved.
MASON KP,TURNER DP,HOULE TT,et al.Hemody-namic response to fluid management in children undergoing dexmedetomidine sedation for MRI[J].,2014,202(6):W574-579.
Dexmedetomidine is administered for pediatric sedation for MRI studies. It has the advantage of preserving respiratory function and producing a sedation state identical to that of natural sleep. It can, however, cause a dose-dependent decrease in systemic blood pressure in children. The purpose of this study was to investigate whether i.v. fluid loading with normal saline solution before the initiation of dexmedetomidine administration would affect the frequency of hypotension.Quality assurance data on consecutively registered children who were sedated with dexmedetomidine for MRI were reviewed. All children received a bolus of 3 g/kg dexmedetomidine followed by a continuous infusion of 2 mg/ kg/h. A normal saline fluid bolus consisting of 0, 10, or 20 mL/kg was administered to each child within 1 hour before initiation of dexmedetomidine administration. Hypotension was defined as a greater than 20% decrease in mean arterial blood pressure from baseline.Sedation was administered to 1692 children. Data on fluid administration were missing in three cases. In the other cases, 252 (14.9%) children received 0 mL/kg of normal saline solution, 598 (35.3%) received 10 mL/kg, and 839 (49.6%) received 20 mL/kg. In a multiple logistic regression model controlled for confounding variables, the odds of development of hypotension with 10 mL/kg of fluid decreased 53% (odds ratio, 0.47; 95% CI, 0.28-0.79; p = 0.004) compared with 0 mL/kg.Administration of 10 mL/kg of normal saline solution before the initiation of dexmedetomidine administration for pediatric MRI sedation is effective in decreasing the incidence of observed hypotension.
BISGAARDT,ROSENBERGJ,KEHLETH.From acute to chronic pain after laparoscopic cholecystectomy:a prospective follow-up analysis[J].,2005,40(11):1358-1364.
Abstract OBJECTIVE: The pathogenesis and risk of chronic pain after cholecystectomy are unknown. In this prospective study of 150 consecutive patients undergoing laparoscopic cholecystectomy, the preoperative clinical data, cold pressor test, state of neuroticism and early postoperative pain intensity were assessed. MATERIAL AND METHODS: Follow-up questionnaires were sent to all patients 1 year after surgery. Patients with moderate/severe chronic pain were interviewed and invited to participate in a structured examination programme. RESULTS: The questionnaire response rate was 100%. Twenty patients reported moderate or severe chronic pain. The 1-year in-office interview revealed that two patients without chronic pain had misinterpreted the questionnaire. Sixteen patients were enrolled for the examination programme. Demonstrable pathology explained the aetiology of chronic pain in 8 patients (5%); another 8 patients with moderate (n=6) or severe (n=2) chronic pain were without pathological findings. In total, 132 patients had no chronic pain. Chronic pain patients suffered significantly more intense acute postoperative pain compared with those without chronic pain (p < or =0.05). The incidence of chronic pain patients was higher in the group of patients with intense acute postoperative pain than in patients with low acute postoperative pain (p = 0.030-0.063). Development of chronic pain was not statistically related to a preoperative cold pressor nociceptive stimulus, preoperative state of neuroticism or to any other variables examined. CONCLUSIONS: The risk of significant chronic pain after laparoscopic cholecystectomy for symptomatic cholecystolithiasis is low but was significantly associated with the intensity of acute postoperative pain. Patients should be carefully examined to exclude somatic causes of chronic pain after laparoscopic cholecystectomy.
GARGP,THAKUR JD,SINGHI.Lower abdominal wall pain and contusion in single-incision laparoscopic cholecystectomy[J].,2010,20(8):713-715.
Abstract There is a surge in interest in single-incision laparoscopic surgery in the recent years. Due to entry of all the ports and instruments from the same incision and obliquity of the instruments, the lowermost port exerts repeated pressure on the infraumbilical abdominal wall. We are reporting 2 cases of single-incision laparoscopic surgery cholecystectomy who presented with lower abdominal pain and contusion in the post operative period.
SMITHH,BRUCKENTHALP.Implications of opioid anal-gesia for medically complicated patients[J].,2010,27(5):417-433.
Opioid analgesics have an established role in the management of postoperative pain and cancer pain, and are gaining acceptance for the management of moderate to severe chronic noncancer pain, most notably chronic low back pain and osteoarthritis, that does not respond to other interventions. Many patients with chronic pain have co-morbid medical conditions that may complicate opioid therapy. Selecting the appropriate opioid requires knowledge of how individual opioids differ with respect to metabolism and interaction with concurrent medications, as well as the reasons why specific medical conditions may influence their efficacy and tolerability. Polypharmacy is a common complicating condition in the elderly and in patients with psychiatric illness, cancer, cardiovascular disease, diabetes mellitus or other chronic illnesses. Polypharmacy, though often necessary for patients with multiple medical conditions, also multiplies the risk of drug interactions. Pharmacokinetic drug interactions can increase or reduce exposure to the opioid or concurrent medications, reducing efficacy and/or tolerability and increasing toxicity. Pharmacodynamic interactions can enhance the depressive effects of opioids, compromising safety. Patients with impaired renal or hepatic function may have difficulty clearing or metabolizing opioids and concurrent medications, leading to increased risk of adverse events. Patients with cardiovascular, cerebrovascular or respiratory disease (including smokers of 2 packs/day with no other diagnosis) may be more susceptible to respiratory depression, bradycardia and hypotension with any opioid, and a few specific opioids pose additional risks. Patients with cerebrovascular disease, dementia, brain injury or psychiatric illness are more susceptible to opioid effects on the CNS, which can include euphoria, cognitive impairment and sedation. Appropriate opioid selection may mitigate these effects. Even in older patients, addiction, abuse and misdirection of prescribed opioids are of concern. Higher risk exists for patients with psychiatric illness, history of substance abuse, and identifiable substance abuse risk factors. Screening for abuse potential and vigilant patient monitoring should be routine. Opioids differ in their ability to produce euphoria, based on opioid receptor agonism, but substance abusers may be more influenced by availability, familiarity and cost factors. Consequently, opioid selection has limited influence on abuse potential but can facilitate ease of monitoring. This review provides an overview of opioid use in medically complicated patients and recommendations on how to optimize analgesia while avoiding adverse events and drug interactions in the clinical setting. Articles cited in this review were identified via a search of EMBASE and PubMed. Articles selected for inclusion discussed characteristics of specific opioids and general physiological aspects of opioid therapy in important patient populations.
HOLZERP.Opioid antagonists for prevention and treatment of opioid-induced gastrointestinal effects[J].,2010,23(5):616-622.
The therapeutic action of opioid analgesics is compromised by peripheral adverse effects, among which constipation is the most disabling as laxatives often fail to provide satisfactory relief. This review highlights recent advances in the specific control of opioid-induced constipation by opioid receptor antagonists with limited systemic bioavailability or a peripherally restricted site of action.The specific management of opioid-induced bowel dysfunction is currently based on three drug entities: oral alvimopan for the shortening of postoperative ileus associated with opioid-induced pain control after bowel resection, subcutaneous methylnaltrexone for the reduction of opioid-induced constipation in patients with advanced illness, and a fixed combination of oral prolonged-release naloxone with prolonged-release oxycodone for the treatment of noncancer and cancer pain. All three drug entities have been shown to attenuate opioid-induced motor stasis in the gut with a favorable adverse effect profile, while the analgesic effect of opioids remains unabated.The availability of opioid receptor antagonists with restricted access to the central nervous system provides a novel opportunity to specifically control opioid-induced constipation and other peripheral adverse effects of opioid analgesics. Further studies are needed to evaluate the long-term efficacy, safety and cost-effectiveness of this approach.
MILICM,GORANOVICT,KNEZEVICP,et al.Complica-tions of sevoflurane-fentanyl versus midazolam-fentanyl anesthesia in pediatric cleft lip and palate surgery:a randomized comparison study[J].,2010,39(1):5-9.
Careful choice of anesthetic agents in pediatric patients reduces the frequency of anesthesia-related complications. The frequency and type of intraoperative and postoperative complications of sevoflurane–fentanyl versus midazolam–fentanyl anesthesia were compared in 140 consecutive children (aged 3 months to 10 years) undergoing cleft lip and palate repair. Midazolam–fentanyl anesthesia was induced with midazolam (0.05 mg/kg), fentanyl (0.005 mg/kg) and vecuronium (0.1 mg/kg), and maintained with the same agents according to the defined parametars. Sevoflurane–fentanyl anesthesia was induced and maintained with sevoflurane (5–8 vol% and 0.8–1 vol%, respectively) in an oxygen/air mixture and supplemented with fentanyl (0.005 mg/kg). Both groups were comparable in basic demographic data, hemodynamic and respiratory parameters. Difficult intubation occurred in 6 of 76 children (midazolam–fentanyl group) and 4 of 64 children (sevoflurane–fentanyl group) ( P = 0.754). Ventricular extrasystole and bronchospasm occurred in one patient each in the sevoflurane–fentanyl group. Postoperatively, emergence agitation was observed in the sevoflurane–fentanyl group (17 cases; P < 0.001); postoperative nausea and vomiting occurred in 2 children (midazolam–fentanyl group) and 3 children (sevoflurane–fentanyl group) ( P = 0.660). Midazolam-based anesthesia in children is safer than sevoflurane-based anesthesia regarding occurrence of emergence agitation.
SAPATEM,ANDURKARU,MARKANDEYAM,et al.To study the effect of injection dexmedetomidine for prevention of pain due to propofol injection and to compare it with injection lignocaine[J].,2015,65(6):466-469.
CIMEN ZS,HANCIA,SIVRIKAYA GU,et al.Compari-son of buccal and nasal dexmedetomidine premedication for pediatric patients[J].,2013,23(2):134-138.
Abstract BACKGROUND: Alpha-2 adrenergic agonists are used to premedicate pediatric patients to reduce separation anxiety and achieve calm induction. The clinical effects of clonidine are similar whether via the oral or nasal route. However, oral dexmedetomidine is not preferred because of its poor bioavailability. The objective of this study was to evaluate the effects of nasal versus buccal dexmedetomidine used for premedication in children. METHODS: Sixty-two patients, aged 2-6 years, undergoing minor elective surgery were randomly assigned to two groups to receive dexmedetomidine, either 1 0204g00·kg(-1) buccally (group B) or 1 0204g00·kg(-1) intranasally (group N) for premedication 45 min before the induction of anesthesia. Heart rate, peripheral oxygen saturation, and respiratory rate were measured before and every 10 min after administering dexmedetomidine in all children. Level of sedation was assessed every 10 min until transport to operating room. Drug acceptance, parental separation, and face mask acceptance scores were recorded. RESULTS: There was no significant difference between the two groups in patient characteristics, nor was there any significant difference between the two groups in heart rate, respiratory rate, or SpO(2) values at all times after premedication. Levels of sedation, parental separation, and mask acceptance scores were significantly higher in group N than in group B at the various times. CONCLUSIONS: These results suggest that intranasal administration of 1 0204g00·kg(-1) dexmedetomidine is more effective than buccal administration of 1 0204g00·kg(-1) dexmedetomidine for premedication in children. 0008 2012 Blackwell Publishing Ltd.