Clinical Observation Of Preoperative Nasal Drip With Different Doses Of Dexmedetomidine In Patients Undergoing Breast Tumor Surgery

ObjectiveTo observe the sedative and anti-anxiety effects of preoperative intranasal administration of different doses of dexmedetomidine in patients undergoing breast tumor surgery,and to further explore the safety and effectiveness of intranasal dexmedetomidine.Methods80 patients from the Second Hospital of Jilin University who were scheduled to undergo elective surgery for breast tumors under general anesthesia from January 2020to December 2020 were enrolled in the study.According to the preoperative intranasal infusion dose of dexmedetomidine（2.0μg/kg,1.5μg/kg,2.0μg/kg,0μg/kg）,the patients were randomly divided into four groups（group D1,group D2,group D3,group C;n=20each）.Patients in each group were given different doses of dexmedetomidine or 0.9%physiological saline intranasally,45-60 minutes before induction of anesthesia.Recording the general condition,the Ramsay sedation score,bispectral index（BIS）,anxiety score（AS）,anxiety visual analog test（AVAT）,mean arterial pressure（MAP）,heart rate（HR）,pulse oxygen saturation（Sp O₂）at 4-time points[before administration（T₀）,15minutes after administration（T₁）,30 minutes after administration（T₂）and 45minutes after administration（T₃）],cardiovascular adverse events and other adverse events,time from nasal drip to room entry,operation time,spontaneous breathing recovery time,wake-up time,extubation time,PACU stay time,VAS score for venipuncture pain,and satisfaction score for anesthesia.Results1.There was no statistical difference in demographics and clinical characteristics of the four groups（P>0.05）.2.Compared with group C,with the prolonged administration time,the Ramsay sedation scores of all three experimental groups significantly increased（P<0.05）,and the BIS significantly decreased（P<0.05）.Both D2 and D3 groups could meet the sedation requirements.3.Compared with group C,with the prolonged administration time,the AS and AVAT of the three experimental groups all significantly increased（P<0.05）.Both the D2 and D3 groups had sufficient anti-anxiety effects.4.Compared with group C,with the prolonged administration time,the Sp O₂ of all three experimental groups didn’t change significantly（P>0.05）,and the HR and MAP of all three experimental groups significantly decreased（P<0.05）.The D3 group reduced the most.Before induction of anesthesia,there were 4 cases of bradycardia（P=0.012）and2 cases of hypotension（p=0.241）in the D3 group,but none in the other groups.There was no statistical difference in the incidence of cardiovascular adverse effects between the four groups during the induction and recovery period of anesthesia（P>0.05）.5.There was no significant difference in the occurrence of nausea,vomiting,chills,and respiratory depression among the four groups（P>0.05）.6.There was no significant difference in the time from intranasal administration to room entry,operation time,spontaneous breathing recovery time,wake-up time,extubation time,and PACU stay time（P>0.05）.7.Compared with group C,the venipuncture pain VAS score of all three experimental groups was significantly reduced（P<0.05）,and the anesthesia satisfaction score was significantly increased（P<0.05）.There was no statistical differences in the VAS score and the anesthesia satisfaction score between the D2 group and the D3 group.ConclusionDexmedetomidine is a safe and effective preoperative medication for breast tumor patients.Preoperative intranasal dexmedetomidine for breast tumor patients has good sedative and anxiolytic effects,which can reduce the pain of venipuncture,improve patients’anesthetic satisfaction,and does not affect their post-anesthetic recovery.When the dexmedetomidine is administered at 1.5μg/kg,the sedative and anti-anxiety effects are significant,and has a slight impact on hemodynamics.It is a more appropriate dosage.