Effects of two preoperative sedative regimens on intraoperative qCON and qNOX and maintenance anesthetic requirements in pediatric total intravenous anesthesia

doi:10.11958/20260438

Abstract

Abstract:

Objective To evaluate the effects of preoperative intranasal dexmedetomidine and intravenous midazolam on anesthesia depth and maintenance drug requirements during pediatric total intravenous anesthesia (TIVA), as monitored by the consciousness index (qCON) and nociceptive index (qNOX). Methods This prospective, randomized, double-blind controlled trial enrolled 79 children (aged 3-6 years, weighing 10-25 kg) scheduled for radiofrequency ablation of tonsils and adenoids. Patients were randomly divided into three groups: group A (no premedication, n=27), group B (intranasal dexmedetomidine 2.0-2.5 μg/kg, n=26), and group C (intravenous midazolam 0.05 mg/kg, n=26). Anesthesia was induced with sufentanil, etomidate, propofol, and cisatracurium, followed by continuous intravenous infusion of propofol and remifentanil. Infusion rates were adjusted intraoperatively to maintain qCON between 40 and 60, and qNOX between 30 and 80. Hemodynamic parameters, qCON and qNOX values, intraoperative infusion doses of remifentanil and propofol, and postoperative recovery profiles were recorded at four time points: before anesthesia induction (T0), before tracheal intubation (T1), 5 minutes after surgery commencement (T2), and before discontinuation of anesthetics (T3). Results During T2-T3, qCON and qNOX values in the group B and C were significantly lower than those in the group A (P<0.05). The maintenance doses of both remifentanil and propofol decreased sequentially across groups A, B, and C. The extubation time in the group C was significantly longer than that in the group A and B (P<0.05), and the richmond agitation-sedation scale (RASS) score during the recovery period was significantly lower in the group C than in the group A and B (P<0.05). Conclusion In pediatric TIVA with propofol and remifentanil, preoperative intranasal dexmedetomidine and intravenous midazolam both deepen anesthesia, reduce qCON and qNOX values, and decrease the required dose of remifentanil. Midazolam can significantly reduce propofol consumption synergistically, but may mildly prolong postoperative extubation time.

Key words: dexmedetomidine, midazolam, quantum nociceptive index, quantum consciousness index, pediatric anesthesia

CLC Number:

R614.2，R765.4

Figures/Tables 4

References 26

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组别	n	年龄/ 岁	体质量/ kg	性别（男/女）	ASA分级（Ⅰ/Ⅱ）	手术时间/min
A组	27	5.0（3.5，5.5）	16.78±2.30	16/11	18/9	33.19±7.83
B组	26	4.5（4.0，5.0）	18.00±2.37	15/11	19/7	35.73±7.16
C组	26	4.0（3.3，5.0）	17.46±1.99	15/11	18/8	35.23±9.16
H、F或χ²		2.376	2.006	0.018	0.260	0.741

组别	n	年龄/ 岁	体质量/ kg	性别（男/女）	ASA分级（Ⅰ/Ⅱ）	手术时间/min
A组	27	5.0（3.5，5.5）	16.78±2.30	16/11	18/9	33.19±7.83
B组	26	4.5（4.0，5.0）	18.00±2.37	15/11	19/7	35.73±7.16
C组	26	4.0（3.3，5.0）	17.46±1.99	15/11	18/8	35.23±9.16
H、F或χ²		2.376	2.006	0.018	0.260	0.741

组别	n		HR/（次/min）
组别	n		T0		T1		T2		T3
A组	27		103.9±7.6		106.9±6.6		111.3±7.7		105.6±7.2
B组	26		95.3±10.3^a		96.1±8.2^a		92.7±7.9^a		95.7±7.2^a
C组	26		97.2±5.1^a		104.5±5.6^b		101.0±5.3^ab		105.2±8.8^b
F			8.617^＊＊		17.720^＊＊		46.957^＊＊		13.628^＊＊
组别		MAP/mmHg
组别		T0		T1		T2		T3
A组		75.0±7.0		76.7±6.3		74.3±5.7		73.9±5.8
B组		75.4±5.1		73.9±5.1		71.3±7.1		70.3±4.6
C组		72.4±8.2		75.8±7.5		72.2±6.6		71.9±6.6
F		1.440		1.307		1.443		2.501

组别	n		HR/（次/min）
组别	n		T0		T1		T2		T3
A组	27		103.9±7.6		106.9±6.6		111.3±7.7		105.6±7.2
B组	26		95.3±10.3^a		96.1±8.2^a		92.7±7.9^a		95.7±7.2^a
C组	26		97.2±5.1^a		104.5±5.6^b		101.0±5.3^ab		105.2±8.8^b
F			8.617^＊＊		17.720^＊＊		46.957^＊＊		13.628^＊＊
组别		MAP/mmHg
组别		T0		T1		T2		T3
A组		75.0±7.0		76.7±6.3		74.3±5.7		73.9±5.8
B组		75.4±5.1		73.9±5.1		71.3±7.1		70.3±4.6
C组		72.4±8.2		75.8±7.5		72.2±6.6		71.9±6.6
F		1.440		1.307		1.443		2.501

组别	n		qCON
组别	n		T0		T1		T2		T3
A组	27		95.3±1.8		39.5±4.5		48.7±5.2		53.5±2.9
B组	26		95.0±1.6		35.5±4.6^a		37.7±6.1^a		44.6±4.2^a
C组	26		95.4±2.0		37.3±4.6		35.6±5.9^a		44.0±4.7^a
F			0.296		5.247^＊＊		40.090^＊＊		47.166^＊＊
组别		qNOX
组别		T0		T1		T2		T3
A组		95.6±1.9		47.3±3.2		52.1±3.8		67.7±6.4
B组		94.8±2.7		33.3±2.7^a		36.9±4.2^a		44.5±4.6^a
C组		94.9±2.0		34.7±3.2^a		34.6±3.1^a		41.5±4.3^a
F		1.131		172.415^＊＊		171.414^＊＊		203.693^＊＊