| Abstract | Uvod: Benzodiazepini su najčešće korišteni sedativi za ublažavanje anksioznosti u bolesnika.
Međutim, oni izazivaju neželjene intraoperacijske učinke, naročito u bolesnika s
opstrukcijskom apnejom tijekom spavanja (OSA). Cilj ovog istraživanja bio je usporediti učinke
sedacije deksmedetomidinom i midazolamom na pojavu intraoperacijskih komplikacija za
vrijeme transuretralnih resekcija mokraćnog mjehura i prostate u spinalnoj anesteziji s
obzirom na rizik za OSA-u. Nadalje, cilj nam je također bio usporediti učinkovitost procjene
rizika za OSA-u pomoću STOP-BANG upitnika i sMVAP indeksa u uroloških bolesnika
podvrgnutih transuretralnoj resekciji mokraćnog mjehura i prostate s pojavnošću
intraoperacijskih komplikacija.
Materijali i metode: Provedeno je randomizirano kontrolirano istraživanje, u koje je bilo
uključeno 115 odraslih bolesnika prosječne starosti 65 godina koji su bili podvrgnuti
transuretralnim urološkim zahvatima. Bolesnici su bili stratificirani u četiri skupine s obzirom
na rizik za OSA-u određen pomoću STOP-BANG upitnika (blagi do umjereni i visoki) i lijek
korišten za sedaciju (deksmedetomidin ili midazolam). Nakon iste početne doze oba su lijeka
dozirana individualno da bolesnici budu u četvrtom i petom stupnju sedacije po Ramsayjevoj
ljestvici. Bilježile su se intraoperacijske komplikacije. Urađena je procjena rizika za OSA-u
pomoću sMVAP indeksa.
Rezultati: Učestalost desaturacija (44% nasuprot 12,7%, p=0,0001), hrkanja (76% nasuprot
49%, p=0,0008), nemira (26,7% nasuprot 1,8%, p=0,0044) i kašlja (42,1% nasuprot 14,5%,
p=0,0001) bila je veća u midazolamskoj skupini u odnosu na deksmedetomidinsku skupinu,
neovisno o riziku za OSA-u. Visoki rizik za OSA-u u bolesnika povećao je učestalost desaturacija
(51,2% nasuprot 15,7%, p<0,0001) i hrkanja (90% nasuprot 47,1%, p<0,0001) u odnosu na
blagi do umjereni rizik za OSA-u, neovisno o korištenom sedativu. Procjena rizika za OSA-u
pomoću sMVAP indeksa pozitivno je korelirala s razvojem komplikacija dišnog puta jer se
povećanjem sMVAP indeksa povećala i učestalost desaturacija i hrkanja.
Zaključak: Sedacija deksmedetomidinom izazvala je manje intraoperacijskih komplikacija u
odnosu na sedaciju midazolamom i u skupini bolesnika s niskim do umjerenim rizikom za OSAu i u skupini bolesnika s visokim rizikom za OSA-u. Nadalje, STOP-BANG upitnik i sMVAP indeks
pokazali su približno jednaku specifičnost, osjetljivost i točnost u predviđanju komplikacija
dišnog puta. |
| Abstract (english) | Background: Benzodiazepines are the most commonly used sedatives for reducing anxiety in
patients.. However, they have adverse intraoperative effects, especially on obstructive sleep
apnea (OSA) patients. This study aimed to compare dexmedetomidine and midazolam
sedation effects on intraoperative complications during transurethral resections of the
bladder and prostate under spinal anesthesia considering the risk for OSA. Furthermore, our
goal was to compare the efficiency of OSA risk assessment measured with a STOP-BANG
questionaire and sMVAP index in patients who underwent transurethral resections of the
bladder and prostate with the incidence of intraoperative complications.
Methods: This study was a randomized controlled trial, which included 115 adult patients
with a mean age of 65 undergoing an urological procedure. Patients were stratified into four
groups based on their OSA risk levels measured with a STOP-BANG questionnaire (low to
medium and high) and whether midazolam or dexmedetomidine were used. The doses were
titrated to reach a score of four or five on the Ramsay sedation scale. Intraoperative
complications were recorded. OSA risk was also measured with an sMVAP index.
Results: Incidence rates of desaturation (44% vs 12.7%, p=0.0001), snoring (76% vs 49%,
p=0.0008), restlessness (26.7% vs 1.8%, p=0.0044) and coughing (42.1% vs 14.5%, p=0.0001)
were higher in the midazolam group compared to the dexmedetomidine group, irrespective
of OSA risk. Having a high risk for OSA increased the incidence rates of desaturation (51.2%
vs 15.7%, p<0.0001) and snoring (90% vs 47.1%, p<0.0001) regardless of the choice of
sedative. OSA risk measured with an sMVAP index was positively correlated with the
development of airway complications, as a higher sMVAP index score increased the incidence
rates of both desaturation and snoring.
Conclusion: Dexmedetomidine led to fewer intraoperative complications than midazolam
during sedation of patients with both low to medium and high risk levels for OSA. The STOPBANG questionnaire and sMVAP index showed similar sensitivity, specificity and accuracy in
prediction of airway complications. |
