Observation Of Different Doses Of Dexmetomidine On Restlessness After Laparoscopic Hysterectomy Under General Anesthesia

Objective:to observe the scores of restlessness,sedation and pain of postoperative patients through the application of different doses of dexmetomidine in laparoscopic hysterectomy under general anesthesia.To determine whether right metomidine has advantages in restlessness and reducing the dosage of painkillers after endoscopic surgery under general anesthesia,and what dose of adverse drug reactions are the least,in order to reduce the incidence of postoperative restlessness and other adverse reactions.Methods:80 patients,female,aged from 40 to 55 years old.The patients were divided into control group and observation group.The operation time was 1.5 to 3 hours.The ASA grade of anesthesia was 1 to 2 grades.According to the digital random grouping method:control group（group C,n=20）,observation group（group D1,n=20,Dex 0.5ug/kg）,observation group（group D2,n=20,Dex 0.7ug/kg）,observation group（group D3,n=20,Dex 1ug/kg）.The patients were injected 0.3 mg scopolamine intravenously 30 hours before operation.After entering the room,they were treated with Mindary 9000multi-functional monitor to monitor ECG,blood pressure,blood oxygen saturation,end-tidal carbon dioxide and other indexes.All cases were anesthetized with endotracheal intubation.Midazolam 2mg,sufentanil0.4mg/kg,vecuronium 0.1mg/kg,etomidate 0.3mg/kg rapid induction,endotracheal intubation followed by mechanically controlled ventilation.The respiratory parameters were as follows:tidal volume8×10ml/kg,frequency10～12 times/min,suction/breath ratio 1:2,oxygen flow 2L/min,PETCO₂maintained at 35-45mmhg.After endotracheal intubation was induced by anesthesia,0.5ug/kg（20ml）in group D,0.7ug/kg（20ml）in group D2 and 1ug/kg（20ml）in group D3 were pumped into groups,60min was pumped in group D,and 20ml saline 60min was pumped in group C.At the same time,the anaesthesia was maintained with Dipramine 3-5mg/kg/h,remifentanil 0.15ug/kg/min,sevoflurane 1%--2%,intermittent（every 30 to 40minutes）intravenous injection of 0.04mg/kg,Stop intravenous injection of vecuronium 30 minutes before the end of the operation,Sufentanil was given0.15ug/kg before the end of the operation,and the patient was transferred to the resuscitation room for resuscitation after the operation.When the anesthesia is not awake,absorb the oral pharynx and endotracheal secretions,reduce the stimulation to the throat and airway.When the patient has spontaneous respiration of 6-8ml/kg,the frequency is 15 to 20 times per minute;the patient is awake,exhaled and can follow the instructions（shaking hands,nodding,etc.）;throat reflex,swallowing reflex,cough reflex recovery;breathing air for three minutes,The endotracheal tube can be removed if the blood oxygen saturation is maintained at more than 95%.Observe for half an hour after extubation and return to the ward after the patient is fully awake.During the period,the SAS restlessness score,VAS pain score,Ramsay sedation grade,the incidence of chills,postoperative vomiting and arrhythmia were recorded in the resuscitation room.Results:at T1 time point,the heart rate in D1 and D2 groups was slower than that in C group（P<0.05）.At T2 time point,the heart rate in D1,D2,D3group was slower than that in C group（P<0.05）,the systolic blood pressure in D2 group was lower than that in C group and D3 group（P<0.05）,and the diastolic blood pressure in D2 group was lower than that in D2 group（P<0.05）.At T3 time point,the heart rate in D1,D2,D3 group was slower than that in C group.Systolic blood pressure in group D2 was lower than that in group C and group D3（P<0.05）,diastolic blood pressure in group D2 was lower than that in group D3（P<0.05）,heart rate in group D1 and D3 was slower than that in group C（P<0.05）,and systolic blood pressure in group D2 and D3 was lower than that in group C（P<0.05）.In terms of restlessness score,the proportion of restlessness in group C was significantly higher than that in other groups（P<0.05）.In terms of pain score,the proportion of pain in group C was higher than that in other groups（P<0.05）.In terms of sedation score,the proportion of 1 score（anxiety,excitement or uneasiness）in group C was higher than that in other groups（P<0.05）.The use of atropine in group D3 was higher than that in other groups（P<0.05）,and the use of atropine in group D2 was higher than that in group D1（P<0.05）.During PACU,the use of additional painkillers in group C was higher than that in other groups（P<0 05）.The retention time of PACU and the time of extubation of endotracheal tube D 3 were longer than those of other groups（P<0 05）.Conclusion:it is found that the use of DEX during operation can reduce the incidence of restlessness after laparoscopic hysterectomy under general anesthesia and reduce the dosage of analgesic drugs.However,there was a decrease in heart rate and blood pressure during use,which was related to the increase of drug dose.It is found that Dex 0.5ug/kg and Dex 0.7ug/kg are safe to use and are recommended to use.