抑制去甲肾上腺素能以降低插管后的脑电唤醒：随机安慰剂对照试验。

BJA open Pub Date : 2024-12-16 DOI:10.1016/j.bjao.2024.100359

Kaitlin Kramer , Thomas Payne , Mitchell Brooks , Jessica Barry , Neha Mahajan , Samantha Malcolm , Hannah Braithwaite , Alex Wang , Chris Thompson , Keith Liyanagama , Robert D. Sanders

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引用次数: 0

摘要

背景：在 40 岁以下的人群中，约有 10% 的人在麻醉诱导后会出现术中意识，但没有明确的回忆。大多数麻醉剂对去甲肾上腺素能系统的抑制作用微乎其微。我们假设，加入右美托咪定可抑制去甲肾上腺素能活性，从而降低气管插管时的脑电图（EEG）唤醒；这种效果将为今后研究右美托咪定降低术中意识奠定基础：方法：进行了一项基于性别分层的单点随机安慰剂对照试验。年龄在18-40岁之间、接受插管全身麻醉的参与者均符合招募条件，并被随机分配接受右美托咪定或安慰剂。右美托咪定（0.5 μg kg-1）在诱导前 5 分钟以负荷剂量给药。在麻醉诱导阶段收集双谱指数（BIS）值，并在气管插管前后使用孤立前臂技术评估患者的反应性。主要结果是右美托咪定对插管前到插管后 BIS 变化的影响：共招募了 51 名患者并纳入主要分析。我们没有观察到右美托咪定对气管插管后 BIS 变化的影响（平均差-1.13，95% 置信区间 [CI] -4.87 至 2.62；P=0.556）。右美托咪定降低了失去响应时的估计血浆异丙酚浓度（差异[右美托咪定-安慰剂]：-1.06 μg ml-1，95% CI -1.66 至 -0.46；p-1，95% CI -2.79 至 -0.90；p结论：右美托咪定在麻醉诱导时显示出了节省麻醉剂的效果，但并不能防止气管插管后的脑电图唤醒，脑电图唤醒的定义是BIS值的增加：临床试验注册：澳大利亚和新西兰临床试验注册中心（试验编号：ACTRN12622000754741）。

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Noradrenergic suppression to reduce electroencephalographic arousal after intubation: a randomised, placebo-controlled trial

Background

Intraoperative awareness, without explicit recall, occurs after induction of anaesthesia in approximately 10% of persons under 40 yr of age. Most anaesthetic agents minimally suppress the noradrenergic system. We hypothesised that addition of dexmedetomidine, which suppresses noradrenergic activity, may reduce encephalographic (EEG) arousal in response to tracheal intubation; such an effect would lay the foundation for future studies of dexmedetomidine in reducing intraoperative awareness.

Methods

A single-site randomised, placebo-controlled trial with sex-based stratification was conducted. Participants, aged 18–40 yr old, undergoing intubation for general anaesthesia were eligible for recruitment and randomly allocated to receive dexmedetomidine or placebo. Dexmedetomidine (0.5 μg kg⁻¹) was given as a 5-min loading dose before induction. Bispectral index (BIS) values were collected during the induction phase of anaesthesia and the isolated forearm technique was used to assess patients' responsiveness before and after tracheal intubation. The primary outcome was the effect of dexmedetomidine on changes in BIS from pre-to postintubation.

Results

A total of 51 patients were recruited and included in the primary analysis. We did not observe an effect of dexmedetomidine on changes in BIS after tracheal intubation (mean difference –1.13, 95% confidence interval [CI] –4.87 to 2.62; p=0.556). Dexmedetomidine reduced the estimated plasma propofol concentration at loss of responsiveness (difference [dexmedetomidine – placebo]: –1.06 μg ml⁻¹, 95% CI –1.66 to –0.46; p<0.001) and before intubation (difference [dexmedetomidine – placebo]: –1.84 μg ml⁻¹, 95% CI –2.79 to –0.90; p<0.001). There was one patient in the placebo group who gave positive responses in the isolated forearm test before and after tracheal intubation.

Conclusions

Dexmedetomidine demonstrated an anaesthetic-sparing effect at induction of anaesthesia but did not prevent EEG arousal after tracheal intubation, as defined by an increase in the BIS value.