Effection Of Different Dexmedetomidine Delivery Modes On Extubation In Elderly Hypertension Patients

Objective:To comparison the effect of different dexmedetomidine delivery modes in the treatment of senile hypertensive patients undergoing PLIF operation during extubation period after general anesthesia.Methods:A total of 90 ASAⅡ-Ⅲhypertension patients were enrolled in this study,aged65-78,and were divided into 3 groups of 30 patients.Group A:Dexmedetomidine 0.5μg·kg^-11 was given 30min before the end of surgery,diluted to 20ml,pumped in 15min.Group B:dexmedetomidine was given to 0.3μg·kg^-1·h^-1during surgical incision to 30min before the end of operation.Group C:No special treatment.The heart rate,MAP were observed 5min after in operaterome（T0）,before extubation（T1）,during extubation（T2）and after extubation at 1min（T3）,3min（T4）,5min（T5）,10min（T6）and 15min（T7）.Other indicators include hypotension or bradycardia during pump,reifen and propofol dosage.Time of eye-opening and extubation,rate of irritability and respiratory depression,Extubation quality score,Ramsay score at PACU,the time of Aldrete≥9.Results:In group A and B,the heart rate was lower in T2-T4 than that in group C（P<0.05）,and there was no difference in other time points.The MAP of group A was lower than that of group C at each time point of T1-T7（P<0.05）and of group B at T2-T4 and T6time point（P<0.05）.The MAP of group B was lower than that of group C at T1,T2,T6,and T7 time point（P<0.05）.Lower incidence of hypotension in group B during pumping than in group A and C.The difference in the incidence of bradycardia was not significant between three groups.The dosage of remifentanil and propofol in group B was reduced by approximately 30%compared with group A and C.The difference of remifentanil consumption was statistically significant（P<0.05）.The difference in propofol dose was not statistically significant but had clinical significance.The extubation quality scores and the Ramsay score when entering PACU in groups A and B were lower than those in group C（P<0.05）.Other indexes were no significant difference between three groups.Conclusion:Both Dexmedetomidine 0.5μg·kg^-1was given 30min before the end of surgery and0.3μg·kg^-1·h^-11 pumped during surgical could relieve extubation response in elderly hypertensive patients,and slight sedation after extubation.Does not affect the recovery and adverse reaction.The former is better than the latter.