| Objective:To compare the clinical anesthesia effects of dexmedetomidine combined with propofol and etomidate in interventional treatment of cerebral aneurysms,so as to find a safer and more effective anesthesia method for interventional treatment of cerebral aneurysms.Methods:110 patients with cerebral aneurysm embolization from April 2017 to August 2018 were selected as the study subjects,The patients were divided into group A and group B by random number table method,all patients received intravenous general anesthesia with retention of spontaneous breathing.The group A was anesthetized with dexmedetomidine combined with propofol,intravenously injected with 1.0 ug/kg fentanyl and 0.5mg/kg-lmg/kg propofol were used to induce anesthesia,intraoperative anesthesia was maintained with 0.3 ug/kg.h dexmedetomidine and target-controlled infusion of 2.0 ug/ml～4.0 ug/ml propofol.When hemodynamics,bispectral index(BIS)and respiratory status changed during operation,propofol was increased or decreased appropriately,the pump was stopped 5 minutes before the end of the operation.Group B was anesthetized with dexmedetomidine and etomidate,intravenous injection was given for 1.0 ug/kg fentanyl and 0.2 mg/kg-0.4 mg/kg etomidate were used to induce anesthesia.During the operation,0.3 ug/kg.h dexmedetomidine was pumped and 0.4 mg/kg.h-0.8 mg/kg.h etomidate was infused to maintain anesthesia.When hemodynamics,BIS monitoring value and respiratory status changed during the operation,etomidate was increased or decreased appropriately,anesthetics were stopped 5 minutes before the end of operation.Compared the changes of BP,HR and SPO2 indexes at different time points of To,T1,T2,T3,T4 between the two groups.Recorded the wake-up time,the time of answering questions accurately,the number of cases of respiratory depression,nausea and vomiting after operation.Results:(1)There was no significant difference in sex,age,height,weight,type of operation and time of operation between the two groups(P>0.05)(see table 1).(2)Comparisons in the same group:In group A,the levels of DBP,SBP,HR and SPO2 at T1,T2 and T3 stages were significantly lower than those at T0 stage(P<0.05),while there was no significant change in group B(P>0.05)(see table 2).(3)Comparisons between the two groups:Compared with group A,the levels of DBP,SBP,HR and SPO2 in T1,T2 and T3 stages in group A were significantly lower than those in group B(P<0.05)(see table 2);the recovery time and the time to answer questions accurately in group B were slightly delayed compared with group A,but there was no statistical difference between the two groups(P>0.05)(see table 3);the incidence of intraoperative respiratory depression in group A was significantly higher than that in group B(P<0.05);the incidence of postoperative nausea and vomiting in group B was significantly higher than that in group A(P<0.05)(see table 4).Conclusion:(1)On the premise of retaining spontaneous breathing,dexmedetomidine combined with propofol and etomidate can play a significant anesthetic effect in interventional surgery of cerebral aneurysms,but each has its advantages and disadvantages.(2)When using dexmedetomidine combined with etomidate anesthesia,the respiratory and hemodynamic system of patients is more stable,but the incidence of nausea and vomiting is higher after operation,and prolonged pumping may cause delayed awakening and inhibition of adrenal cortical function;when using dexmedetomidine combined with propofol anesthesia,the incidence of postoperative nausea and vomiting is lower.However,it has obvious inhibitory effects on respiratory and cardiovascular system.(3)During the embolization of cerebral aneurysms with spontaneous breathing under general anesthesia,anesthetics should be selected according to the preoperative cardiovascular function,the characteristics of the patient’s condition and the estimated operation time. |
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