Effects Of Dexmedetomidine Nasal Drops On Preoperative Anxiety, Local And Systemic Inflammation In Patients With Sinusitis: A Prospective, Randomized, Controlled Clinical Trial

Objective:The objective of this study was to investigate the effects of Dexmedetomidine（D ex）nasal drops on preoperative anxiety,nasal mucosa and systemic inflammation in p atients with chronic sinusitis complicated with nasal polyps（CRSwNP）.Methods:This study is a prospective randomised controlled trial.We selected 64 patients with CRSwNP who underwent endoscopic sinus opening under elective general anest hesia at our institution from January 2022 to July 2022 and who presented with preop erative anxiety.The general condition and anxiety state of the CRSwNP patients were evaluated1 day before surgery.Patients meeting the experimental exclusion criteria were select ed and randomly divided into 2 groups by random number table method,with 32 case s in each group.The groups were as follows:experimental group:Dexmedetomidine2μg/kg（Dex group）nasal drops;Control group:constant volume normal saline（NS group）nasal drip.64 patients entered the anesthesia preparation room 60 min before e ntering the operating room.After electrocardiographic monitoring and oxygen inhalat ion,corresponding groups of drugs were injected into the nasal cavity of the operative side.Sixty minutes after nasal drip,the patients were transferred to the operating roo m for anesthesia operation.Anesthesia induction and intraoperative anesthesia mainte nance were the same in the two groups.Age,sex,Body Mass Index（BMI）,ASA grad ing,preoperative hospital Anxiety and Depression Scale（HADS）score,operative dur ation,and intraoperative Bispect Ral Index（BIS）were recorded in the two groups.He art rate（HR）,mean arterial pressure（MAP）and pulse oxygen saturation（Sp O₂）were recorded at 7 moments before nasal drip（T₀）,10 min（T₁）,30 min（T₂）,60 min（T₃）,im mediately after intubation（T₄）,beginning of surgery（T₅）and ending of surgery（T₆）.The sedation scores（OAA/S）before nasal drip（T₀）and 60 min after nasal drip（T₃）w ere recorded in both groups.Intervention with ephedrine hydrochloride injection or at ropine injection if MAP and HR decrease by 20%or more from basal values.Before and 60 minutes after nasal drip（T₃）,the middle 1/3 of the nasal inferior turbinate and a small amount of secretions on the nasal mucosal surface of the nasal septum on the administration side were scraped and stained.The number of central granulocytes and eosinophil granulocytes were observed by microscope.Then Meltzer’S semi-quantita tive grading was used to score the number of cells.Meltzer’S semi-quantitative gradi ng scores were recorded before（T₀）and 60 min after（T₃）intranasal infusion.2 ml of peripheral venous blood was extracted from each of the patients at 3 time points befor e nasal drip（T₀）,immediately after intubation（T₄）and immediately after surgery（T₆）.The contents of interleukin-6（IL-6）,interleukin-8（IL-8）and tumor necrosis factor-α（TNF-α）were detected by Elisa and recorded.Results:1.General information:No statistically significant differences were found betwee n the two groups in terms of gender,age,BMI,ASA classification,preoperative HAD S score,and duration of surgery and intraoperative BIS values（P>0.05）.2.Comparison of OAA/S score before and after nasal drip:There was no statistic al difference in OAA/S scores between the two groups before the nasal drip（P>0.05）,and the OAA/S scores of the Dex group were significantly lower than those of the N S group following the nasal drip,with differences that were statistically significant（P<0.01）.3.Comparison of nasal inflammation before and after nasal drip:Intra-group com parison:There was no statistical difference in Meltzer’S semi-quantitative classificati on scores at the nasal septum and inferior turbinate between the two groups before the nasal drip（P>0.05）;there was a statistical difference in Meltzer’S semi-quantitative classification scores at the nasal septum and inferior turbinate between the two groups after the nasal drip（P<0.05）,and the Dex group was smaller than the NS group.Wit hin-group comparison:There was no statistical difference in Meltzer’S semi-quantitati ve classification scores at the nasal septum and inferior turbinate in the NS group afte r nasal drip compared with those before nasal drip（P>0.05）;there was a statistical di fference in Meltzer’S semi-quantitative classification scores at the nasal septum and i nferior turbinate in the Dex group after nasal drip compared with those before nasal d rip（P<0.05）The post-nasal drip was smaller than the pre-nasal drip.4.Comparison of serum inflammation:The differences in serum concentrations o f TNF-α,IL-6,and IL-8 between the two groups of patients before nasal drip were not statistically significant（P>0.05）.After the nasal drip,the serum concentrations of T NF-α,IL-6,and IL-8 were higher in both groups at two time points,immediately afte r intubation（T₄）and immediately after the end of surgery（T₆）,compared with the mo ment of T₀.However,the concentrations of TNF-α,IL-6,and IL-8 were significantly lower in the Dex group at the time points of T₄and T₆compared to the NS group,and the difference was found to be statistically significant（P<0.05）.5.MAP comparison:Prior to nasal drip,there was no statistically significant diffe rence in MAP between the two groups（P>0.05）.The difference was statistically sign ificant（P<0.05）for each T₁-T₆MAP in the Dex group after nose drops,and statistica lly significant（P<0.05）for each T₁-T₄MAP in the NS group after nose drops（P>0.05）and for each T₅and T₆MAP below T₀.MAP in Dex group was lower than that in NS group at all T₁-T₆time points after nasal drips,with statistically significant differe nces（P<0.05）.In both groups,MAP did notdecrease by more than 20%from the bas eline value at each time point from T₁-T₆without the use ofpharmacological intervent ion.6.HR comparison:Prior to nasal drip,there was no statistically significant differ ence in HR between the two groups（P>0.05）.In the Dex group,HR at the T₁-T₆time points was less than that at the T₀time point after the nasal drip,and the difference w as found to be statistically significant（P<0.05）.In the NS group,the HR of patients a t the T₁-T₃time points was not statistically significant（P>0.05）compared with the T₀time points,and the HR at the T₄-T₆time points was lower than the T₀time points,with a statistically significant difference（P<0.05）.HR was lower in Dex group than NS group at all T₁-T₆time points after nasal drips,with statistically significant differe nces（P<0.05）.Without drug pharmacological intervention HR in both groups decrea sed by no more than 20%from baseline value for T₁-T₆at each point in time.7.SPO₂comparison:There was no statistical difference in SPO₂between the two groups before the nasal drip（T₀）（P>0.05）.Conclusion:Dex nasal drops are not only safe and effective in relieving preoperative anxiety in CRSwNP patients,but also in reducing the nasal mucosal and systemic inflammato ry responses in CRSwNP patients.