Effect of Intravenous Dexmedetomidine Premedication on Sufentanil Median Effective Concentration During Tracheal Intubation in Obese Patients: A Randomized Controlled Study.

IF 5.1 2区医学 Q1 CHEMISTRY, MEDICINAL Drug Design, Development and Therapy Pub Date : 2025-02-24 eCollection Date: 2025-01-01 DOI:10.2147/DDDT.S491599

Qi Zeng, Jinjie Li, Yanrong Liu, Yiran Zhang, Hang Su, Faping Tu

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Abstract

Purpose: Sufentanil is a potent opioid analgesic frequently used to suppress the tracheal intubation response. The pathophysiological changes of obesity may affect opioid pharmacokinetics and increase the risk of opioid-induced adverse effects. Dexmedetomidine as an adjunct to anesthetic induction could save the dosage of sufentanil and attenuate hemodynamic response to tracheal intubation. This study was aimed at investigating the effect of intravenous dexmedetomidine premedication on the median effective concentration (EC50) of sufentanil for tracheal intubation in obese patients.

Patients and methods: Fifty obese patients undergoing elective bariatric or non-bariatric surgery under general anesthesia with tracheal intubation were equally randomized into the dexmedetomidine group and the saline group. Depending on the group, the patients were intravenously premedicated with 1 μg/kg dexmedetomidine or saline before anesthesia induction. Anesthesia was induced with target-controlled infusion of propofol (at 3.5 μg/mL) and sufentanil. The effect-site concentration of sufentanil for the first patient in the two groups was set at 0.4 ng/mL. The concentration of sufentanil for the next patient was determined using Dixon's up-and-down sequential method with an interval of 0.05 ng/mL, according to the responses of the previous patient. Hemodynamic variables and sufentanil dose were recorded. The EC50 and 95% confidence interval (CI) of sufentanil were determined using probit regression analysis.

Results: The EC50 of sufentanil and 95% CI were 0.25 (95% CI, 0.17-0.31) ng/mL in the dexmedetomidine group and 0.43 (95% CI, 0.34-0.46) ng/mL in the saline group (P < 0.05). The dosage of sufentanil was significantly lower in the former than in the latter. The hemodynamics were stable in both groups during the study.

Conclusion: Intravenous premedication with 1 μg/kg dexmedetomidine significantly decreased the EC50 of sufentanil and sufentanil requirement for tracheal intubation in obese patients.

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右美托咪定预用药对肥胖患者气管插管期间舒芬太尼中位有效浓度的影响：一项随机对照研究。

目的：舒芬太尼是一种强效阿片类镇痛药，常用于抑制气管插管反应。肥胖的病理生理变化可能影响阿片类药物的药代动力学，增加阿片类药物引起的不良反应的风险。右美托咪定辅助麻醉诱导可节省舒芬太尼用量，减轻气管插管血流动力学反应。本研究旨在探讨右美托咪定预用药对肥胖患者气管插管舒芬太尼中位有效浓度（EC50）的影响。患者和方法：50例肥胖患者在全麻下气管插管行选择性减肥或非减肥手术，随机分为右美托咪定组和生理盐水组。分组麻醉诱导前分别静脉滴注右美托咪定1 μg/kg或生理盐水。靶控输注异丙酚（3.5 μg/mL）和舒芬太尼诱导麻醉。两组患者首例舒芬太尼起效部位浓度均为0.4 ng/mL。根据上一位患者的反应，采用Dixon上下顺序法测定下一位患者的舒芬太尼浓度，间隔为0.05 ng/mL。记录血流动力学参数及舒芬太尼剂量。采用probit回归分析确定舒芬太尼的EC50和95%置信区间（CI）。结果：右美托咪定组舒芬太尼EC50和95% CI分别为0.25 (95% CI, 0.17 ~ 0.31) ng/mL和0.43 (95% CI, 0.34 ~ 0.46) ng/mL （P < 0.05）。前者的舒芬太尼用量明显低于后者。两组患者血流动力学均稳定。结论：静脉预用药1 μg/kg右美托咪定可显著降低肥胖患者舒芬太尼EC50及气管插管舒芬太尼需用量。

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来源期刊

Drug Design, Development and Therapy CHEMISTRY, MEDICINAL-PHARMACOLOGY & PHARMACY

CiteScore

9.00

自引率

0.00%

发文量

382

审稿时长

>12 weeks

期刊介绍： Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications. The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas. Specific topics covered by the journal include: Drug target identification and validation Phenotypic screening and target deconvolution Biochemical analyses of drug targets and their pathways New methods or relevant applications in molecular/drug design and computer-aided drug discovery* Design, synthesis, and biological evaluation of novel biologically active compounds (including diagnostics or chemical probes) Structural or molecular biological studies elucidating molecular recognition processes Fragment-based drug discovery Pharmaceutical/red biotechnology Isolation, structural characterization, (bio)synthesis, bioengineering and pharmacological evaluation of natural products** Distribution, pharmacokinetics and metabolic transformations of drugs or biologically active compounds in drug development Drug delivery and formulation (design and characterization of dosage forms, release mechanisms and in vivo testing) Preclinical development studies Translational animal models Mechanisms of action and signalling pathways Toxicology Gene therapy, cell therapy and immunotherapy Personalized medicine and pharmacogenomics Clinical drug evaluation Patient safety and sustained use of medicines.