The Annals of thoracic surgery · 2019
Dexmedetomidine Sedation After Tracheal Surgery: A Prospective Pilot Study.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Fiorelli Silvia, Creazzola Fiamma, Massullo Domenico, Defraia Veronica, Maggi Luigi, Rocco Monica, Rendina Erino Angelo
Аннотация
BACKGROUND: Fourteen adults undergoing tracheal resection and reconstruction surgery were enrolled in this prospective observational pilot study to evaluate dexmedetomidine-based sedation after tracheal surgery in an intensive care unit.
METHODS: Patients remained electively intubated with an uncuffed nasal endotracheal tube, awake and exhibiting spontaneous breathing. The neck was maintained in flexion through chin-to-chest sutures. Infusion of dexmedetomidine was started from a dosage of 0.7 μg·kg-1·h-1 followed by dose titration to the target level of the sedation Richmond Agitation Sedation Scale (RASS) score -1 to -2 using a dose range of 0.2 to 1.4 μg·kg-1·h-1.
RESULTS: The mean sedation levels were within the target ranges during the entire 18-hour observation period with a significant decrease in RASS (baseline RASS, 1.43 ± 0.51; 18h RASS -0.86 ± 0.95; p < 0.005). The mean arterial pressure (MAP) and heart rate (HR) were significantly decreased during dexmedetomidine infusion (baseline MAP 90.29 ± 14.33 mm Hg versus 18-hour MAP 82.50 ± 15.44 mm Hg; baseline HR 81.50 ± 12.76 beats/min versus 18-hour HR 69.29 ± 10.21 beats/min; p < 0.005). The visual analog scale (VAS) scores significantly decreased (baseline VAS 4.14 ± 0.86 versus 18-hour VAS 2.79 ± 0.67; p < 0.005). Peripheral oxygen saturation did not exhibit any significant decrease. Bradycardia occurred in 1 patient who assumed beta-blocker therapy without significant changes in blood pressure and was resolved by titration of the infusion without suspending sedation. No cases of delirium were encountered, and no additional sedative or analgesic was required.
CONCLUSIONS: Dexmedetomidine provided safe and effective sedation after tracheal surgery in spontaneous breathing patients without causing respiratory depression.
METHODS: Patients remained electively intubated with an uncuffed nasal endotracheal tube, awake and exhibiting spontaneous breathing. The neck was maintained in flexion through chin-to-chest sutures. Infusion of dexmedetomidine was started from a dosage of 0.7 μg·kg-1·h-1 followed by dose titration to the target level of the sedation Richmond Agitation Sedation Scale (RASS) score -1 to -2 using a dose range of 0.2 to 1.4 μg·kg-1·h-1.
RESULTS: The mean sedation levels were within the target ranges during the entire 18-hour observation period with a significant decrease in RASS (baseline RASS, 1.43 ± 0.51; 18h RASS -0.86 ± 0.95; p < 0.005). The mean arterial pressure (MAP) and heart rate (HR) were significantly decreased during dexmedetomidine infusion (baseline MAP 90.29 ± 14.33 mm Hg versus 18-hour MAP 82.50 ± 15.44 mm Hg; baseline HR 81.50 ± 12.76 beats/min versus 18-hour HR 69.29 ± 10.21 beats/min; p < 0.005). The visual analog scale (VAS) scores significantly decreased (baseline VAS 4.14 ± 0.86 versus 18-hour VAS 2.79 ± 0.67; p < 0.005). Peripheral oxygen saturation did not exhibit any significant decrease. Bradycardia occurred in 1 patient who assumed beta-blocker therapy without significant changes in blood pressure and was resolved by titration of the infusion without suspending sedation. No cases of delirium were encountered, and no additional sedative or analgesic was required.
CONCLUSIONS: Dexmedetomidine provided safe and effective sedation after tracheal surgery in spontaneous breathing patients without causing respiratory depression.