右美托咪定静脉用药增强眼心反射
Intravenous dexmedetomidine augments the oculocardiac reflex
背景与目的：我们先前已经报道经鼻右美托咪定预用药与更强烈的眼心反射（OCR）有关。在本研究中，我们进行了一次体内静脉用药比较，以验证我们的假设，即这种α2肾上腺素能激动剂能增强三叉-迷走神经反射。
1
方法：在斜视手术中，采用10秒，200 g张力方波对下直肌或其他肌肉进行OCR（最大改变心率/基线心率）前瞻性监测。在第一和第二肌肉OCR之间，右美托咪定0.5μg/kg静脉泵注。
结果：所有患者均无应用抗胆碱能药物。共842名历史对照病人（中位年龄，5.5岁）在行肌肉第一次OCR（75%±24%）和第二次OCR（77%±22%）间没有静脉给与右美托咪定。33名研究对象（中位年龄，5.6岁）行肌肉第一次OCR（84%±16%），静脉给与右美托咪定行第二次OCR（66%±25%），心动过缓增加18%±19%(P<0.01)。
结论：与芬太尼的作用相似，静脉快速推右美托咪定可增强眼外肌牵引引起的心动过缓。
BACKGROUND:
We reported that premedication with nasal dexmedetomidine was associated with a more intense oculocardiac reflex (OCR). In this study we performed an intrasubject, intravenous comparison to test our hypothesis that this alpha-adrenergic agonist potentiates the trigemino-vagal reflex.
METHODS:
OCR (greatest change heart rate/baseline heart rate) was prospectively monitored with 10-second, square-wave 200 g tension on the inferior rectus or other muscles during strabismus surgery. Between the first and second muscle, intravenous dexmedetomidine 0.5 μg/kg was delivered.
RESULTS:
All patients had no anticholinergic agents. A total 842 historic control patients (median age, 5.5 years) with no dexmedetomidine between muscles experienced the first OCR of 75% ± 24% (SD) and the second OCR of 77% ± 22%. The 33 study patients (median age, 5.6 years) experienced the first OCR 84% ± 16% and dexmedetomidine second OCR of 66% ± 25% for a bradycardia augmentation of 18% ± 19% (P < 0.01 [Mann-Whitney]).
CONCLUSIONS:
Similar to the effect of fentanyl, intravenous fast-push dexmedetomidine augmented the bradycardia associated with extraocular muscle traction.
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