Effects Of Different Timing Of Dizocine Administration On The Anesthesia Effect In Endoscopic Nasal Surgery

Objective:To investigate the effects of dizocine on anesthetic effect in nasal endoscopic surgery with preoperative,intraoperative and both preoperative and intraoperative administration combined Narcotrend monitoring.Methods:A total of 120 patients who met the criteria and received endoscopic nasal surgery in the Second Affiliated Hospital of Shantou University Medical College from January 2017 to December 2018 were randomly divided into 4 groups by random number table method.N0 group was the Control group（Con group）,N1 group was the preoperative medication group（Pre M group）,and N2 group was the Intraoperative medication group（Intra M group）,and N3 group was assigned Preoperative and intraoperative medication（Pre&Intra M group）,with 30 cases in each group.The Con group was the blank control,that is,no dizocine was used during anesthesia.The Pre M group received 0.15mg/kg dizocine intravenously 15min before surgery,the Intra M group was intravenously injected with dizocine 0.15mg/kg 30min before surgery,and the Pre&Intra M group was intravenously injected with dizocine0.05mg/kg 15min before surgery,and the Pre&Intra M group was intravenously injected with dizocine 0.1mg/kg 30min before the end of surgery.Anesthesia regimen and controlled antihypertensive methods remained the same for each group.Anesthesia induction:midazolam 0.05mg/kg,fentanyl 4μg/kg,propofol 2 mg/kg,atracurium 0.8 mg/kg.Anesthesia maintenance drugs:remifentanil 0.1～0.4μg·kg^-1·min^-1,propofol 4～12 mg·kg^-1·h^-1,atacurium 0.3～0.6 mg·kg^-1·h^-1,with stable vital signs maintained at the same depth of anesthesia/consciousness（D2～E1）.During controlled hypotension,nitroglycerin was injected with an intravenous pump of 5～20μg/min,and the systolic blood pressure was monitored between 80 and 95 mm Hg or the mean arterial blood pressure was between 50 and 65mm Hg.When the heart rate was lower than 50 or more than 100 mm Hg/min,a single intravenous injection of atropine 0.01～0.02 mg/kg or esmolol 0.5～1mg/kg was given.Nitroglycerin pumping was stopped when the surgeon completed the critical procedure,and atracuramide pumping was stopped 30 minutes before the end of surgery.After surgery,all patients were sent to the post-anesthesia recovery room,where they were connected to the anesthesia machine and continued mechanical ventilation until the recovery of respiration reached the standard of extubation,and the endotracheal catheter could not be removed.Age,body weight,mean arterial pressure（MAP）and heart rate（HR）of the 4 groups were recorded,as well as 10 min of in-room resting（T0）,10 min of intraoperative hypotension（T1）,10 min of intraoperative hypotension（T2）,30min of intraoperative hypotension（T3）,30min before surgery（T4）,at the end of surgery（T5）,and 10 min of intraoperative extubation（T6）.At the same time,operative time,blood loss,respiratory recovery time,eye opening time by call,extubation time,the number of patients receiving nitroglycerin and the amount of nitroglycerin were recorded.The postoperative agitation and pain were assessed.Results:1.Therewere no statistically significant differences in body weight,age,operation time and blood loss among all groups.2.Compared with the other three groups,the recovery time,extubation time and respiratory recovery time of Pre M group were significantly decreased（P<0.05）.3.Compared with the other three groups,postoperative respiratory recovery time,recovery time and extubation time in Intra M group were increased（P<0.05）,and VAS score was decreased（P<0.05）.4.Compared with the other three groups,the use of nitroglycerin in Con group was significantly increased（P<0.05）,the postoperative pain score and the number of cases of postoperative agitation were significantly increased（P<0.05）Conclusion:The use of dizocine under Narcotrend EEG awareness monitoring can reduce the use of antihypertensive drugs in endoscopic nasal surgery,effectively reduce postoperative pain and reduce the incidence of restlessness during the recovery period.Preoperative administration of dizocine can reduce the time of anesthesia resuscitation,and intraoperative administration of dizocine can prolong the time of anesthesia resuscitation,but can reduce postoperative pain.