Effect Of Different Routes And Doses Of Dexmedetomidine For The Prevention Of Catheter-related Bladder Discomfort In Patients Undergoing General Anesthesia For Mid-and Upper Abdominal Surgery

Objective:To investigate the effectiveness and differences in outcomes of different routes of administration and doses of dexmedetomidine（Dex）for the prevention of catheter-related bladder irritation signs（CRBD）in patients undergoing general anesthesia for mid-and upper abdominal surgery.Methods:1.90 male patients undergoing mid-upper abdominal surgery under general anesthesia were randomly divided into 3 groups（n=30 patients）:30 min before the end of the surgery,group AI:Dex 0.2ug/kg by intravesical instillation;group BI:Dex0.4ug/kg by intravesical instillation;group CI:Dex 0.6ug/kg by intravesical instillation;after administration,the ureter was clamped shut for 30 min and then opened.The incidence and severity of CRBD,urethral pain（NRS）score,sedation（Ramsay）score,adverse effects,and postoperative remedial drug use in the immediate postoperative period（T₀）,1h（T₁）,2h（T₂）,and 6h（T₃）,were recorded and compared with the time of awakening and extubation in each group.Then choose an appropriate dose.2.59 male patients undergoing mid-upper abdominal surgery under general anesthesia were selected:they were randomly divided into two groups:Dex 0.4ug/kg via intra-urethral bladder+intravenous pumping of equal saline（group I,n=29patients）and Dex 0.4ug/kg via intra-urethral bladder+intra-urethral bladder filling of equal saline（group V,n=30 patients）.The administration method and observation index were the same as in the first part of the experiment.Results:1.Compared with the AI group,the incidence of CRBD,urethral NRS score,and postoperative remedial drug use were reduced in the BI and CI groups at T_0-3（P<0.05）,and the severity of CRBD was also reduced in the BI and CI groups at T_0-1（P<0.05）.There was an increase in the Ramsay score at T₀ in the BI group（P<0.05）and an increase in the Ramsay score at T_0-1 in the CI group（P<0.05）,but there was no significant difference in the comparison of the severity of CRBD and the Ramsay scores at the remaining time points（P>0.05）.Compared with the BI group,the CI group had a lower incidence and severity of CRBD,urethral NRS score,and postoperative remedial drug use at T_0-3,but the difference was not statistically significant（P>0.05）.The CI group had a higher Ramsay score at T_0-1（P<0.05）,while there was no significant difference in the comparison of Ramsay scores at T_2-3（P>0.05）.There was no significant difference in the comparison of time to awakening,time to extubation,and incidence of adverse events in the three groups（P>0.05）.2.Compared with the group I,group V had a higher Ramsay score at T_0-1（P<0.05）,and there was no significant difference in the Ramsay score at T_2-3（P>0.05）;the remaining indicators were not significantly different between the two groups（P>0.05）.Conclusions:1.Intravesical infusion of Dex 0.4ug/kg via the ureteral bladder 30 min before the end of surgery was more effective than doses of 0.2ug/kg and 0.6ug/kg for the prevention of postoperative CRBD in patients undergoing mid-upper abdominal surgery under general anesthesia.2.Compared with intravenous pumping of Dex 0.4ug/kg,intravesical infusion of Dex 0.4ug/kg 30 min before the end of surgery also reduced the incidence and early severity of postoperative CRBD in patients undergoing general anesthesia for mid-and upper abdominal surgery,relieved postoperative urethral pain without significant side effects,and provided a more appropriate degree of sedation.