デクスメデトミジン投与が小児のロクロニウム誘発性神経筋遮断および挿管状態に及ぼす影響：ランダム化比較試験

Dexmedetomidine is an a₂-adrenoreceptor agonist with sedative, analgesic, and anxiolytic properties. It has gained remarkable attention in the adult and pediatric population predominantly because of its minimal respiratory depression. However, in the pediatric population, very limited information is available regarding the action of intravenous dexmedetomidine on neuromuscular blockade and on anesthesia induction. The aim of this study was to investigate the impact of dexmedetomidine on rocuronium-induced neuromuscular blockade and on anesthesia induction with propofol in children.

A total of 60 children undergoing elective surgery, ages 4-12 years, were enrolled in the study. Before the induction of anesthesia with propofol, 30 children received dexmedetomidine 0.5 μg/kg given over 10 min (group D). Another group of 30 children received the same volume of N/S 0.9% over 10 min as well (group P). We recorded time to achieve TOF = 0 from the end of rocuronium infusion, time for BIS < 60 from the end of propofol infusion, intubation conditions, haemodynamic changes, intubation attempts, and adverse effects.

The onset time of rocuronium was significantly lower in group D compared to group P (177.8 s, 95% CI 161.1-194.0 s vs 205 s, 95% CI 188.0-222.0 s; p = 0.021). Time for BIS to reach a value < 60 (34.3 s, 95% CI 29.1-39.6 s for group D vs 33.2 s, 95% CI 27.2-39.2 s for group P, p = 0.772) was unaffected by dexmedetomidine infusion. Intubation conditions showed a more stable haemodynamic response in group D (systolic, diastolic, mean arterial pressure, and heart rate were significantly lower in group D at intubation). No difference was found regarding intubation attempts and adverse effects.

Our results showed that dexmedetomidine infusion before induction of anesthesia with propofol reduced the onset time of rocuronium and provided a better hemodynamic profile during endotracheal intubation in children.

The study protocol was registered in ClinicalTrials.gov (NCT03923075).