The Effect Of Nalmefene On General Anesthesia Recovery Period After Partial Hepatic Resection

Objective To study the effect of nalmefene on recovery in patients undergoing partial hepatic resection.Methods Sixty patients undergoing partial hepatic resection in our hospital from July 2020 to February were selected.Patients with ASAⅠ-Ⅱ,they were assigned into two groups randomly,with 30 patients in each group.The two groups were Group A（saline）,Group B（nalmefene 0.25μg/kg）,all patients were visited one night before operation.All patients received preoperative visit before surgery,and were routinely prohibited from drinking and fasting before surgery.After entering the operating room,peripheral venous access was opened,and routine monitoring of ECG,NIBP,Sp O₂and BIS was performed.The radial artery was punctured and catheterized under ultrasound guidance under local anesthesia,and a pressure transducer was connected to monitor IBP.Internal jugular vein puncture and catheterization were performed to monitor CVP.Anesthesia induction and maintenance:Target controlled infusion concentrations of propofol and remifentanil were set at 3-4μg/ml and 3-4 ng/ml,respectively.After the patient lost consciousness,cisatracurium 0.2mg/kg was injected intravenously,and endotracheal intubation was performed after muscle relaxation and completion.And combined with 0.25%ropivacaine,rectus abdominis plane block and right serratus anterior nerve block were performed.Intraoperative combined inhalation anesthesia was used,and BIS values were maintained between 40 and 60.During the operation,cis-atracurium0.1mg/kg was intermittently given as needed to maintain muscle relaxation and ensure sufficient anesthesia depth to avoid intraoperative anesthesia.Fentanyl 2μg/kg was given before the surgery begins,and vasoactive drugs were used to maintain hemodynamic stability when necessary.30 mins before the end of the operation,stop using dexmedetomidine and inhalation of anesthetic gas,at the same time intravenous fentanyl 2μg/kg,at the end of the surgery to stop using propofol and remifentanil,group B patients were injected nalmefene described above at the end of surgery,patients with the same capacity of group A and 0.9%sodium chloride injection,surgery after putting the patient into PACU,reached after extubation indications pulling the endotracheal tube.After the patient is vital signs are stable and the anesthesia recovery room standard is reached,the patient is sent back to the ward for further treatment.The experiment monitoring indexes in the study including:（1）recorded patient characteristics:Gender,age,height,weight,BMI and operation time,anesthesia time and blood loss.（2）MAP and HR were recorded at T0 and 5min（T1）,10min（T2）and 30min（T3）after admission to the recovery room.The modified OAA/S score and Ramsay sedation score at 5min（S1）,10 min（S2）and 30min（S3）after extubation,and recording the postoperative side-effects.Results There were no significant differences between the two groups with respect to Gender,age,height,weight,BMI and operation time,anesthesia time and blood loss（P>0.05）.There were no significant differences between the two groups with MAP and HR at T0,T1,T2,T3,and the postoperative side-effects.（3）Compared with Group A,The recovery time and the extubation time were shorter in Group B.The modified OAA/S score in group B at S1 and S2 was significantly higher than that in group A,and the Ramsay sedation score in group B at S1 was significantly lower than that in group A,with statistical significance（p<0.05）.Conclusions During anesthesia of patients undergoing partial hepatic resection,injecting nalmefene 0.25μg/kg at the end of surgery can significantly shorten the recovery time of postoperative spontaneous breathing,recovery time,extubation time and recovery room residence time.Shorten the resuscitation time,improve patient comfort,make the patients more safe and stable during the resuscitation.To improve the quality of anesthesia resuscitation.