关键词: 右美托咪啶, 瑞芬太尼, 清醒气管插管

Abstract: AIM: To observe the application effects of dexmedetomidine combined with remifentanil for awake endotracheal intubation. METHODS: Seventy five patients scheduled for uvulopalatopharyngoplasty (UPPP) under general anesthesia and trachea intubation were divided into 3 groups: fentanyl combined with droperidol group (Group FD, n=25), midazolam combined with remifentanil group (Group MR, n=25) and dexmedetomidine combined with remifentanil group (Group DR, n=25). Group FD: intravenous injection of fentanyl with the dose of 2 μg/kg and droperidol with the dose of 0.08 mg/kg; Group MR: after intravenous injection of midazolam with the dose of 0.05 mg/kg and remifentanil with the dose of 1.0 μg/kg within 1 minute, remifentanil was given with the dose of 0.06 μg·kg^-1·min^-1 until the success of trachea intubation; Group DR: after intravenous injection of dexmedetomidine with the dose of 0.6 μg/kg within 10 minutes, remifentanil was given with the dose of 1.0 μg/kg by intravenous injection within 1 minute and remifentanil was given with the dose of 0.06 μg·kg^-1·min^-1 until the success of trachea intubation. Ramsay score were all no less than 4 before trachea intubation. Mean arterial pressure (MAP) and heart rate (HR) at the time of entrance (T₀), the time before laryngoscopy placement (T₁) and the point of trachea intubation (T₂) were recorded. The time of trachea intubation, respiratory depression, patients tolerance in the process of trachea intubation and postoperative forgotten were all also recorded. RESULTS: Compared with group FD, MAP and HR in group MR and group DR at the time of T₀ were not significantly different (P>0.05) while MAP and HR both decreased significantly between T₁ and T₂ (P<0.05). In addition, the descend of MAP and HR in group DR were larger than those in group MR(P<0.05). Patients in group MR and group DR felt more comfortable than those in group FD (P<0.05), the number patients with postoperative forgotten was smaller than that in group FD (P<0.05) and the number of patients with respiratory depression in group DR was smaller than that in group FD and group MR.CONCLUSION: Dexmedetomidine combined with remifentanil inhibits stress reaction of patients with consciousness in the process of endotracheal intubation.Patients feel comfortable in the process of endotracheal intubation and some patients have postoperative forgotten. No obvious respiratory depression occurs.

Key words: Dexmedetomidine, Remifentanil, Awake endotracheal intubation