Optimum ratio of medicine dosage for dexmedetomidine mixed with sufentanil used for PCIA after Nuss procedure in pediatric patients with pectus excavatum

Abstract

Objective To evaluate the optimum ratio of medicine dosage for dexmedetomidine mixed with sufentanil used for patient-controlled intravenous analgesia (PCIA) after Nuss procedure in pediatric patients with pectus excavatum. Methods Sixty pediatric patients diagnosed with pectus excavatum, aged 5-12 yr, weighing 18-50 kg, of ASA physical status Ⅰ or Ⅱ, scheduled for elective Nuss procedure under general anesthesia, were randomly divided into 3 equal groups using a random number table: different ratios of medicine dosage while dexmedetomidine was added to sufentanil groups (SD1-3 groups) . Postoperative analgesia was as follows: group SD1 received sufentanil 1 μg/kg + dexmedetomidine 2 μg/kg; group SD2 received sufentanil 1 μg/kg + dexmedetomidine 3 μg/kg; group SD3 received sufentanil 1 μg/kg + dexmedetomidine 4 μg/kg. A mixture of tropisetron 0.1 mg/kg and dexamethasone 0.1 mg/kg (in 100 ml of normal saline) was added in each group. The PCA pump was programmed to deliver 0.5 ml with a lockout interval of 15 min and background infusion at 2 ml/h. The PCA pump was connected immediately after the end of operation, and sufentanil with a dosage of 0.1 μg/kg was used as a rescue analgesic within 48 h postoperatively. The VAS score was maintained below 4. The requirement for rescue analgesics was recorded. The Ramsay sedation scores was recorded at 4, 8, 12, 24 and 48 h postoperatively, and the occurrence of adverse reactions such as nausea and vomiting, bradycardia, over-sedation, respiratory depression, agitation and shivering was recorded within 48 h after surgery. Results No pediatric patients developed nausea and vomiting, respiratory depression, bradycardia, over-sedation, and shivering. No pediatric patients required rescue analgesics in SD2 and SD3 groups. Compared with group SD1, the requirement for rescue analgesics and incidence of agitation were significantly decreased, and Ramsay sedation scores were increased at 4 and 8 h after operation in SD2 and SD3 groups. Ramsay sedation scores were significantly higher at 4 h after operation in SD3 group than in SD2 group. Conclusion Dexmedetomidine 3 μg/kg mixed with sufentanil 1 μg/kg is the optimum ratio of medicine dosage when used for PCIA after Nuss procedure in pediatric patients with pectus excavatum. Key words: Dexmedetomidine; Sufentanil; Funnel chest; Analgesia, patient-controlled