Observation Of The Anesthesia Effect Of Dexmedetomidine Combined With Remifentanil In Percutaneous Left Atrial Appendage Occlusion

BackgroundAtrial fibrillation is a common arrhythmia that cause thrombus formation in the left atrium,especially the left atrial appendage.When the thrombus falls off,it will lead to embolism in the systemic arterial system.Percutaneous Left Atrial Appendage Closure（LAAC）has a good preventive effect on the formation of thrombus in the left atrial appendage.In recent years,the operation has been successfully completed under monitored anesthesia care.Dexmedetomidine and remifentanil have been widely used in monitored anesthesia care due to their special pharmacological effects,and we already have a lot of experience in the combined use of the two drugs.ObjectiveThis study used the combined use of dexmedetomidine and remifentanil in the monitored anesthesia care of LAAC patients,aiming to observe the patient’s intraoperative vital signs,anesthesia effect,recovery status and adverse reactions of the combined medication.And we hope the results can provide a theoretical basis for the selection of anesthetic drugs for patients undergoing left atrial appendage occlusion under monitored anesthesia care.Methods62 patients who met the inclusion criteria and planned to undergo LAAC were randomly assigned to the research group and the control group according to the single and double days of the operation date.2 cases were excluded,and 30 cases were eventually enrolled in each group.The control group was intravenously pumped with a loading dose of 1μg/kg of dexmedetomidine within 10-15 minutes,followed by a maintenance dose of 0.2-0.7μg/（kg·h）.The research group injected remifentanil 0.1～0.3μg/（kg·min）on the basis of pump injection of dexmedetomidine.Combined with local infiltration anesthesia,the depth of anesthesia was adjusted according to the Ramsay sedation depth score during the operation.The changes of pulse rate（PR）and mean arterial pressure（MAP）were observed and compared between the two groups before operation（T₀）,when the esophageal ultrasound probe was inserted（T₁）,when the inguinal local infiltration anesthesia（T₂）,when the atrial septal puncture（T₃）,when the left atrial appendage occluder was released（T₄）,and when the patient was awake after operation（T₅）The occurrence of body movement and choking at different time points;Additional times of etomidate;The incidence of intraoperative respiratory depression,apnea and hypoxemia in 2 groups;Time to wake up after surgery,pain condition after waking up,and whether inhalation pneumonia occurred.ResultsThe MAP and PR of the research group at T₁ were significantly lower than those of the control group（P<0.05）,and the PR at T₂ of the research group was significantly lower than that of the control group（P<0.05）.There was no statistically significant difference in the other time points;the research group and the control group did the differences within and between the groups were statistically significant（P<0.05）;the research group was significantly better than the control group in body movement,coughing and use of etomidate（P<0.05）;There was no occurrence of respiratory depression,apnea and hypoxemia in 2 groups during operation;In terms of postoperative awakening,the control group had shorter awakening time than the tesearch group,and the difference was statistically significant（P<0.05）.VAS score of the two groups after waking up was lower in the study group than in the control group,and the difference was statistically significant（P<0.05）;there was no aspiration pneumonia in the two groups.ConclusionDexmedetomidine combined with remifentanil for percutaneous left atrial appendage occlusion can reduce the incidence of coughing and body movement in patients during the operation,reduce hemodynamic fluctuations and improve the quality of recovery.