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異なる用量のデクスメデトミジン注入による逆行性挿管の評価。無作為化比較試験
Evaluation of retrograde intubation with different doses of dexmedetomidine infusion: A randomised controlled trial.
PMID: 32637307 PMCID: PMC7327427. DOI: 10.1016/j.jobcr.2020.06.002.
抄録
背景:
逆行性挿管は、困難な気道管理の代替方法としてよく知られている方法の一つである。効果的な鎮静と患者の準備が必要である。本研究では，2種類の用量のデクスメデトミジンを用いて逆行性挿管時の挿管状態を評価した．
Background: Retrograde intubation is one of the well-described and alternative methods of difficult airway management. It requires effective sedation and patient preparation. Study was done to evaluate intubating conditions during retrograde guided intubation with two different doses of dexmedetomidine.
方法:
本試験は、気道困難患者60名を対象とした前向き無作為化二重盲検並行群間比較試験である。患者を2群に分け，デクスメデトミジン1.0μg/kg（A群）とデクスメデトミジン1.5μg/kg（B群）のいずれかを静脈内（IV）経路で投与した。一次転帰としてModified Observer Assessment Awareness and Sedation（AAA/S）を測定し、二次転帰として、気管挿管のしやすさ、顔面笑みスコア、咳の重症度、血行動態反応、患者の想起、不快感を評価した。
Methods: This prospective randomized double blind parallel group trial was planned on 60 patients with difficult airway. Patients were divided in two groups to receive either dexmedetomidine 1.0 μg/kg (Group A) or dexmedetomidine 1.5 μg/kg (Group B) by intravenous (IV) route. The Modified Observer Assessment Awareness and Sedation (OAA/S) was measured as primary outcome and ease of intubation, facial grimace score, cough severity, hemodynamic response, patient recall and discomfort were assessed as secondary outcome during awake retrograde intubation.
研究結果:
両群は人口統計学的パラメータとベースラインパラメータの点で同等であった。血行動態パラメータはB群の方が良好であり、逆行挿管時にも有意な差が認められたが、挿管のしやすさ、挿管時間、合併症は両群間で有意な差は認められなかった(P>0.05)。しかし、気管挿管のしやすさ、気管挿管時間、合併症は両群間で有意差（P>0.05）は認められなかった。
Results: Groups were comparable in terms of demographic and baseline parameters. OAA/S (P = 0.001), cough severity (P < 0.001), facial grimace score (P < 0.001), grading of discomfort during procedure (P < 0.001) and recall of procedure scale (P = 0.038) were found significantly better/lower in Group B as compared to Group A. Hemodynamic parameters were better in Group B and showed significant difference during the retrograde intubation. However, ease of intubation scale, intubating time and complications were not significantly different (P > 0.05) between the two groups.
結論:
逆行性挿管は簡単に習得でき、合併症を最小限に抑えて行うことができる。デクスメデトミジンの1.5μg/kg静注量は、臨床的に管理可能な副作用を伴う逆行性挿管に最適で安全である。
Conclusion: Retrograde intubation can be easily learned and performed with minimal complications. Dexmedetomidine in a dose of 1.5 μg/kg IV is optimum and safe for retrograde intubation with clinically manageable side effects.
© 2020 Published by Elsevier B.V. on behalf of Craniofacial Research Foundation.