关键词: 右美托咪定, 滴鼻, 骶管阻滞, 镇静

Abstract: Objective:To investigate the application of non-intravenous dexmedetomidine(DEX) in the pediatric patients underwent lower abdomen and limb surgery, and to observe the sedative effect of DEX in this procedure. Methods: Sixty patients undergoing the general anesthesia for lower abdomen and limb surgery were selected and randomly devided into ropivacaine sacral block (RS) group, intranasal DEX + ropivacaine sacral block (ID) group, ropivacaine + DEX sacral block (DS) group, 20 cases in each group. The children in ID group received intranasal DEX 1 μg·kg^-1 30 min before operation and the children in RS and DS groups received physiological saline. 1 mL·kg^-1 propofol was infused intravenously in the children who could not smoothly enter into the operating room as well as the intolerance to oxygen mask or sevoflurane inhalation while induction. The children in RS and ID groups received 0.25% ropivacaine 1 mL·kg^-1, and the children in DS group received the same dose of ropivacaine mixed with 1 μg·kg^-1 DEX, and the total volume of drugs was 20 mL. The general information of each child was recorded; the sedation status when separated from their parents and induction period mask and sevoflurane acceptance scores were assessed; the satisfaction of separation with parents, oxygen mask and sevoflurane inhalation were recorded; the time of operation, induction, extraction of laryngeal mask and anesthesia awake were recorded; delayed awakening,laryngismus and awakening period agitation score were recorded. The scores of anesthesia recovery and the dosage of propofol were recorded; the sedation scores 4, 8, 12, 16, 20, and 24 h after operation were recorded. Results: Compared with RS and DS groups, the sedation scores of the children when they were separated from their parents and mask induction and sevoflurane inhalation acceptance, the satisfaction degree of separation, mask and sevoflurane acceptance in ID group were increased(P<0.05); the dosage of propofol in ID group were decreased(P<0.05). The time of operation, extraction of laryngeal mask and anesthesia awake had no significant differences between three groups (P>0.05), the induction time of children in ID group was shorter than those in RS and DS groups(P<0.05). There was no delayed awakening in three groups, and the laryngismus and the awakening period agitation score in RS group were higher than those in ID and DS groups (P<0.05). There was no differences in the consciousness, respiration, activity scores and the scores of anethesia recovery between three groups(P>0.05). The sedation scores in the three groups were less than 3 points 4 h after operation. Compared with RS group, the sedation scores in ID and DS groups were decreased 8 h after operation (P<0.05). Compared with RS and ID groups, the sedation scores in DS group 12, 16 and 20h after operation were decreased(P<0.05). There were no significant differences in the sedation scores between three groups 24 h after operation (P>0.05). Conclusion: When non-intravenous DEX is used in the pediatric patients underwent lower abdomen and limb surgery, the children can quietly and co-operationly enter into the operating room and quickly and smoothly complete the induction process; the incidence of revival restlessness is significantly reduced, and it can play a role in the early postoperative sedation.

Key words: intranasal, caudal block, sedation, dexmedetomidine