儿童扁桃体切除术后心动过缓是否与术中右美托咪定的使用有关？
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Postoperative bradycardia following adenotonsillectomy in children: Does intraoperative administration of dexmedetomidine play a role?
背景与目的
右美托咪定作为一种新型药物，其在伴睡眠呼吸暂停综合征（OSA）的患儿扁桃体切除术中常作为辅助用药。尽管右美托咪定安全有效，但其中枢交感神经阻断效应引起的低血压与心动过缓等副作用不容忽视。出于安全考虑，本团队对扁桃体切术后OSA患儿进行夜间心肺功能监测，在监测过程中，我们不少发现心动过缓的患儿，因此本研究拟探讨扁桃体切除术后OSA患儿行动过缓是否与术中右美托咪定使用有关。
方 法
本实验为回顾性队列研究，我们回顾性分析了11个月内的记录，比较了接受右美托咪定和未接受右美托咪定的扁桃体切除术后患儿心动过缓的发生率。
结 果
本队列研究共纳入921例患儿，术中接受右美托咪定的共371例，未接受右美托咪定的共550例；心动过缓总发生率为7.2%（66例患儿）；所有患儿心动过缓及临床表现均不需要医护措施干预，两组间心动过缓发生率无明显差异。
结 论
本研究结果表明：儿童扁桃体切除术心动过缓与术中右美托咪定使用无直接关系，心动过缓的发生可能受心肺功能监测技术的影响。
原始文献摘要
Bush B, Tobias J D, Lin C, et al. Postoperative bradycardia following adenotonsillectomy in children: Does intraoperative administration of dexmedetomidine play a role?[J]. Int J Pediatr Otorhinolaryngol, 2018, 104:210-215.
Introduction: Dexmedetomidine is a novel pharmacologic agent that has become a frequently used adjunct during care of pediatric patients with obstructive sleep apnea (OSA) undergoing tonsillectomy. While generally safe and effective,
dexmedetomidine is associated with adverse effects of hypotension and bradycardia from its central sympatholytic effects. Due to safety concerns, our institution routinely admits patients with OSA for overnight cardiorespiratory monitoring following tonsillectomy. With such monitoring, we have anecdotally noted bradycardia in our patients and sought to investigate whether this was related to the increased use of intraoperative dexmedetomidine.
Methods: We retrospectively reviewed records over an 11-month period to compare the incidence of postoperative bradycardia following hospital admission for
tonsillectomy in patients who received dexmedetomidine versus those who did not.
Results: The study cohort included 921 patients (371 received dexmedetomidine and 550 did not). Bradycardia was asymptomatically noted in 66 patients (7.2%). No patient required medical intervention for the bradycardia or developed clinical symptoms. There was no association of bradycardia with the intra-operative administration of dexmedetomidine (8.9% of patients who received dexmetomidine vs. 9.4% who did not). In multivariable analysis, bradycardia was more common among older patients, with the administration of topical or injected lidocaine, and with specific associated procedures (inferior turbinate coblation with out-fracture or direct laryngoscopy and bronchoscopy).
Conclusion: The increased incidence of asymptomatic bradycardia in our post-adenotonsillectomy patients seemed to relate more to increased utilization of postoperative cardiac telemetry, and did not appear associated with the use of dexmedetomidine use intra-operatively.
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