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Title: [Study of comparing dexmedetomidine and remifentanil for conscious sedation during radiofrequency ablation of hepatocellular carcinoma].
Author: Sun HT, Xu M, Chen GL, He J.
Journal: Zhonghua Yi Xue Za Zhi; 2018 Feb 27; 98(8):576-580. PubMed ID: 29534384.
Abstract:
Objective: This study aimed to compare dexmedetomidine with remifentanil for conscious sedation in patients undergoing radiofrequency ablation of hepatocellular carcinoma. Methods: Sixty patients, who were aged 41 to 73 years with American Society of Anesthesiologists (ASA) physical status Ⅰ-Ⅱ, and scheduled for elective radiofrequency ablation of hepatocellular carcinoma under conscious sedation in National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, from January 2014 to June 2016, were allocated randomly to receive dexmedetomidine maintenance regimen(group D, n=30)or remifentanil maintenance regimen(group R, n=30)by random digital table. Subjects in group D received dexmedetomidine at a loading dose of 0.5 μg/kg over 10 min followed by 0.2-1.0 μg·kg(-1)·h(-1) infusion until Ramsay sedation scale reached 3-4. Patients in group R received a loading dose of remifentanil 1 μg/kg followed by remifentanil 4-10 μg·kg(-1)·h(-1) infusion and propofol 1-2 mg·kg(-1)·h(-1) infusion until Ramsay sedation scale reached 3-4. Haemodynamic variables, respiratory rate(RR), pulse oxygen saturation (SpO(2))and numeric rating scales(NRS) in each group were collected at entrance(T(0)), puncturing(T(1)), 15 min after beginning of radiofrequency ablation(T(2)), the end of radiofrequency ablation(T(3)) and 30 min after operation(T(4)). Efficacy of anesthesia, incidences of intraoperative respiratory depression, postoperative nausea and vomiting, patient and surgeon satisfaction were evaluated. Results: Compared with group D, the arterial blood pressure and heart rate at T(2) [(92.2±15.7)mmHg vs (102.4±16.7)mmHg, (69.7±15.3) beats/min vs (79.4±17.7) beats/min] and respiratory rate at T(1), T(2) and T(3) [(10.1±1.9) breaths/min vs(12.3±1.7) breaths/min, (10.8±1.5) breaths/min vs(13.6±1.6) breaths/min, (13.4±1.6) breaths/min vs(14.5±1.4)breaths/min] were significantly lower in group R (t=-2.437, -2.271, -4.726, -6.993, -2.834, all P<0.05). With less sulfentanil consumption(23.2±8.3)μg vs( 35.5±11.7)μg, group R got less NRS at T(2) and T(3)(2.4±1.1) vs(3.5±1.2), (2.4±1.3) vs(3.6±1.1), and higher NRS at T(4)(3.4±1.1) vs( 2.1±0.9) than group D(t=-4.696, -3.701, -3.860, 5.010, all P<0.05). Compared with group R, the incidence of intraoperative respiratory depression was significantly lower (23.3% vs 56.7%)and the incidence of inadequate anesthesia(20% vs 0) was significantly higher in group D(χ(2)=5.625, 4.630, both P<0.05). Conclusion: Both dexmedetomidine and remifentanil can be successfully used for conscious sedation in patients undergoing radiofrequency ablation of hepatocellular carcinoma. Remifentanil maintenance regimen provides better intraoperative analgesia and operative condition, while dexmedetomidine is superior to remifentanil in reducing intraoperative respiratory depression and postoperative pain. 目的：观察对比肝癌射频消融术患者应用右美托咪啶和瑞芬太尼清醒镇静的临床效果。 方法：选择国家癌症中心/中国医学科学院北京协和医学院肿瘤医院2014年1月至2016年6月择期行肝癌射频消融手术、美国麻醉医师协会(ASA)Ⅰ～Ⅱ级、年龄41～73岁患者60例，采用随机数字表法将其分为：右美托咪啶组(D组)和瑞芬太尼组(R组)，每组30例患者。D组患者10 min内静脉输注负荷右美托咪啶0.5 μg/kg，随后以0.2～1.0 μg·kg(－1)·h(－1)的速度持续输注，直至Ramsay镇静评分达到3～4分；R组患者静脉输注负荷剂量瑞芬太尼1 μg/kg，随后持续静脉输注瑞芬太尼4～10 μg·kg(－1)·h(－1)和丙泊酚1～2 mg·kg(－1)·h(－1)，直至Ramsay镇静评分达到3～4分。记录患者进入手术室(T(0))、穿刺时(T(1))、射频消融开始后15 min(T(2))、射频消融结束退针时(T(3))以及术后30 min时(T(4))的血液动力学指标、呼吸频率、脉搏血氧饱和度(SpO(2))和镇痛数字评分(NRS)。评估麻醉效果，记录术中呼吸抑制、术后恶心呕吐发生情况，统计患者和手术医生满意度。 结果： R组患者T(2)时刻的血压和心率分别为(92.2±15.7)mmHg和(69.7±15.3)次/min，低于D组的(102.4±16.7)mmHg和(79.4±17.7)次/min，差异有统计学意义(t＝－2.437、－2.271，均P<0.05)。R组患者在T(1)、T(2)和T(3)时的呼吸频率分别为(10.1±1.9)、(10.8±1.5)和(13.4±1.6)次/min，低于D组的(12.3±1.7)、(13.6±1.6)和(14.5±1.4)次/min，差异均有统计学意义(t＝－4.726、－6.993、－2.834，均P<0.05)。术中R组舒芬太尼用量为(23.2±8.3)μg，明显少于D组的(35.5±11.7)μg，R组T(2)和T(3)时NRS分别为(2.4±1.1)和(2.4±1.3)分，低于D组的(3.5±1.2)和(3.6±1.1)分，R组T(4)时NRS为(3.4±1.1)分，高于D组的(2.1±0.9)分，差异均有统计学意义(t＝－4.696、－3.701、－3.860、5.010，均P<0.05)。D组患者术中呼吸抑制发生率(23.3%)低于R组(56.7%)，差异有统计学意义(χ(2)＝5.625，P<0.05)。D组麻醉效果差的发生率(20.0%)高于R组(0)，差异有统计学意义(χ(2)＝4.630，P<0.05)。 结论：右美托咪啶和瑞芬太尼均可成功用于肝癌射频消融术患者的清醒镇静麻醉，瑞芬太尼在术中镇痛方面以及改善术者操作条件方面具有优势，右美托咪啶在减少患者术中呼吸抑制和控制术后疼痛方面更好。.

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