Effect Of Dexmedetomidine On Post-operative Neuro-cognitive Dysfunction In Patients Undergoing Plasma Resection For Benign Prostatic Hyperplasia

Objectives In this study,the elderly male patients undergoing transurethral plasma kinetic resection of the prostate（TUPKP）under general anesthesia are divided into two groups.Whether dexmedetomidine（DEX）is used in anesthesia is compared.Finally,the heart rate（HR）,mean arterial pressure（MAP）,dosage of general anesthesia,cerebral oxygen saturation（r SO₂）and S100βProtein,IL-6 and TNF-α、MMSE score of the two groups are compared to determine whether DEX can reduce the incidence of post-operative neuro-cognitive dysfunction（PNCD）in elderly male patients undergoing TUPKP.Methods From November 2020 to June 2021,57 elderly patients who underwent TUPKP under general anesthesia were selected as the research objects,aged 65～75 years,ASA grade I～II.They were randomly divided into DEX group（Group D,n=28）and control group（Group C,n=29）.After entering the operating room,the patient is covered with a body surface heating blanket,and the set temperature is 38℃,with medium air volume to maintain the body temperature.Monitor electrocardiogram（ECG）,pulse oxygen saturation（Sp O₂）,noninvasive arterial blood pressure（NIBP）and cerebral oxygen saturation（r SO₂）.Anesthesia induction:followed by intravenous injection of propofol injection 1.5 mg/kg and sufentanil citrate injection 0.3～0.4μg/kg,rocuronium injection0.6 mg/kg to complete anesthesia induction.After the patient’s consciousness disappeared,oxygen and nitrogen were removed for 3 minutes,and the laryngeal mask was placed to ensure that the position of the laryngeal mask was correct,the respiratory sounds of both lungs were consistent through auscultation,the laryngeal mask was fixed,and the anesthesia machine was connected for mechanical ventilation.Anesthesia maintenance:remifentanil hydrochloride was injected intravenously during operation 0.05～0.2μg/kg/min and propofol injection 4～12 mg/kg/h until the end of the operation,intermittent intravenous injection of 0.2 mg/kg rocuronium injection to maintain muscle relaxation,and vasoactive drugs to maintain circulatory stability when necessary.Group D was injected with intravenous pump after opening the venous access 0.6μg/kg DEX was pumped for 15minutes,and then changed to 0.4μg/kg/h was continuously pumped until the drug was stopped 30 min before the end of the operation.Group C was injected with equal volume normal saline for control.After the operation,the patient should be conscious and return to normal swallowing reflex,open eyes,raise hands,raise head,spontaneously breathe tidal volume 8～10ml/kg,breathe air for 3 minutes,Sp O₂>93%,aspirate sputum,remove throat mask,observe for 15 minutes and then return to the ward.During the experiment,trained researchers collected venous blood at 16～17 hours:1 day before operation（T₀）,postoperative day（T₁）,1 day after operation（T₂）,3 day after operation（T₃）,and 5 day after operation（T₄）.After centrifugation,the upper serum was taken,and the specific protein of S100βProtein,IL-6 and TNF-αwas determined by enzyme-linked immunosorbent assay（ELISA）.MMSE score test was conducted at T_0-4 time point.HR,MAP and r SO₂ were recorded at four time points anesthesia induction（t₀）,operation start（t₁）,operation end（t₂）and out of the operating room（t₃）.Results 1 Comparison of general data:there was no significant difference in age,BMI,Hemoglobin（Hb）and operation time between the two groups（P>0.05）.2Comparison of propofol dosage of intravenous general anesthesia:the dosage of propofol injection in group D was significantly lower than that in group C（P<0.05）.3HR comparison:in group D,there was significant difference between t_1-3 and t₀（P<0.05）.There was significant difference between t₁,t₂ and t₀ in group C（P<0.05）,but there was no significant difference between t₁ and t₂（P>0.05）.There was significant difference between t₃ and t₁,t₂（P<0.05）.There was significant difference in t₀ and t_1-3between the two groups（P<0.05）.MAP comparison:in group D,there was significant difference between t_1-3 and t₀（P<0.05）.There was significant difference between t₁,t₃and t₀ in group C（P<0.05）,but there was no significant difference between t₀ and t₂（P>0.05）;t₃ was statistically significant compared with t₁ and t₂（P<0.05）.There was no significant difference in t₀ and t₃ between the two groups（P>0.05）,and there was significant difference in t_1-2（P<0.05）.4 There was no significant difference in r SO₂between the two groups at t_0-3 time point（P>0.05）.5 Intra group comparison,S100βProtein,IL-6,TNF-αat T_1-3 time point compared with T₀,the difference was statistically significant（P<0.05）.T₄ compared with T₀,S100βProtein and IL-6increased,the difference was statistically significant（P<0.05）,TNF-αwas no significant difference（P>0.05）.S100βProtein,IL-6 and TNF-αat each time point of T_0-4 was compared between groups,the difference was not statistically significant（P>0.05）.6 There was no significant difference in MMSE score between group D and group C at T_0-4 time point（P>0.05）.In this study,2 cases of PNCD occurred in group D after operation,and the incidence rate was 7.1%.There were 2 cases of PNCD in group C,the incidence was 6.9%,and the difference was not statistically significant（P>0.05）.Finally,the two groups of experimental data and the occurrence of PNCD were compared.Conclusions 1 Dexmedetomidine in general anesthesia can reduce the dosage of propofol in elderly male patients undergoing TUPKP.2 Dexmedetomidine in general anesthesia can reduce the HR of elderly male patients undergoing TUPKP.The HR and MAP are more stable than those without dexmedetomidine.3 Dexmedetomidine had no significant effect on r SO₂ in elderly male patients undergoing TUPKP.4Dexmedetomidine in general anesthesia has no significant effect on the prevention of postoperative inflammatory response and the S100βProtein rise in elderly male patients undergoing TUPKP.5 Dexmedetomidine can provide stable circulatory perfusion for elderly male patients undergoing TUPKP.It has no obvious effect in reducing the incidence of postoperative PNCD,which still needs further observation.Figure7;Table6;Reference 145...