| BackgroundWith the increase of outdoor anesthesia and day surgery,how to ensure the anesthetic effect and safety of these patients has become one of the clinical focuses.China is a country with high prevalence of hepatitis B.The incidence of hepatitis B cirrhosis and esophagogastric varices is very high.It is characterized by a large amount of bleeding,rapid onset,complicated complications and patients in a critical condition.The mortality of it is as high as 40%.The anesthesia of patients undergoing endoscopic surgery in the endoscopy center is the representative of outdoor anesthesia.On the premise of safety,it requires fast induction and revival,perfect sedation,stable hemodynamics,no obvious residual effect and slight adverse reaction.This is a new challenge for us.Until now,most of these surgeries are treated with conscious sedation or local anesthesia.Study shows that the incidence of hemorrhage is still up to 20%after esophageal variceal ligation and sclerotherapy,especially during the recovery period,30%-50%of which has a risk of reflux aspiration.Therefore,how to reduce the perioperative stress,to reduce the risk of hemorrhage and reflux aspiration,to maintain stable hemodynamics and to wake up completely is the key point of this study during the perioperative period.ObjectivesTo evaluate the safety and efficacy of sevoflurane anesthesia and propofol anesthesia during endoscopic variceal ligation(EVL)and/or endoscopic variceal sclerotherapy(EVS),and to assess the safety and efficacy of different doses of dexmedetomidine combined with sevoflurane anesthesia during EVL and/or EVS.MethodsPart I:120 American Society of Anesthesiologists(ASA)physical status III or? patients,aged 40 years to 70 years undergoing general anesthesia for endoscopic variceal ligation(EVL)and/or endoscopic variceal sclerotherapy(EVS),were randomly divided into 2 groups:Sevoflurane anesthesia(group S,n=60),propofol anesthesia(group P,n=60).Vital signs especially heart rate(HR)and mean artery pressure(MAP)were monitored.The designated time points were as follows:5 minutes before induction(T0),1,5,10,15,20,25,30 minutes after intubation(T1,T2,T3,T4,T5,T6,T7).Time intervals were recorded including recovery time and extubation time.Record the observer's assessment of Ramsay sedation scale(RSS)and visual analogue scale(VAS)5 minutes after extubation.Adverse reactions and satisfaction of patients/anesthetists were noted.Part II:160 ASA physical status ? or ? patients,aged 40 years to 70 years undergoing general anesthesia for EVL and/or EVS,were randomly divided into 4 groups:normal saline combined with sevoflurane anesthesia(group A,n=40),0.2?g·kg-1,0.5?g·kg-1?1?g·kg-1 dexmedetomidine combined with sevoflurane(group B,group C and group D,n=40).Vital signs especially HR and MAP were monitored.The designated time points were as follows:5 minutes before administration(TO),5 minutes and 10 minutes after administration(T1,T2),1,5,10,15 minutes after intubation(T3,T4,T5,T6),the time of drug discontinued(T7),the time of wake up(T8),and the time immediately after extubation(T9).Time intervals were recorded including recovery time and extubation time.Record the observer's assessment of RSS score and VAS score 5 minutes after extubation.Adverse reactions were noted.ResultsPart I:There were significant differences in MAP between two groups at T2,T3,T5,T6 as well as T7(P<0.05).There was significant difference in HR between two groups at T2,T3,T4(P<0.05).Recovery time and Extubation time in group P were longer than those in group S(P<0.05)(18.38 ± 2.25 min vs.14.57 ± 1.04 min,21.70 ± 2.70 min vs.15.83 ± 0.88 min).Rate of ephedrine injected was 58.3%(35 out of 60 patients)in group P vs.28.3%(17 out of 60 patients)in group S(P<0.05).There was significant difference in the RSS score between the two groups 5 minutes after extubation(P<0.05).VRS score showed that anesthetist and patients were much more satisfied with the procedure in group S than those in group P(P<0.01).Part II:There were significant differences in MAP and HR between group A and group C at T2,T8 and T9(P<0.05).There were significant differences in MAP and HR between group A and group D at T2 to T9(P<0.05).There were significant differences in MAP and HR between group B and group C at T2,T8 and T9(P<0.05).There were significant differences in MAP and HR between group B and group D at T2 to T9(P<0.05).There were significant differences in MAP between group C and group D at T3 to T9,and There were significant differences in HR between group C and group D at T2 to T9(P<0.05).Rate of atropine injected was 25%in group D,There were significant differences of which between group D and other groups.Recovery time and extubation time of group D was 20.32±2.78 min and 21.31±2.87 min,There was significant difference between group D and other groups(P<0.05).There was no significant difference between group A,B,C in recovery time and extubation time(P>0.05).There was significant difference in the RSS and VAS score between group C and other groups 5 minutes after extubation(P<0.05).There was significant difference in the RSS and VAS score between group D and other groups 5 minutes after extubation(P<0.05).VRS score showed that anesthetists and patients were much more satisfied with the procedure in group C than those in other groups(P<0.05).ConclusionThe superiority and special clinical value of inhalational anesthesia have been confirmed during EVL and/or EVS attributed to stable hemodynamics and high quality of anesthetic recovery in the study,The superiority and advantages of 0.5?g·kg-1 of dexmedetomidine combined with inhalational anesthesia also have been confirmed because of alleviation of patients' anxiety and stress reaction,stable hemodynamics,inhibition of intubation and extubation response,these all may reduce not only the risks of hemorrhage and reflux aspiration but also occurrency of cardiocerebral events. |
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