| Oral and maxillofacial surgery patients are usually congenital malformation children, the elderly tumor patients, obstructive sleep apnea syndrome (obstructive sleep apnea syndrome, OSAS) patients, and maxillofacial trauma patients.These patients have different degrees of mouth limited and airway obstruction, perioperative risks are significantly increased.To ensure the safety of patients, anesthetists often do awake tracheal intubation for patients before anesthesia.But doing awake endotracheal intubation for patients, although improving the patient’s safety,but the pain and stress from the stimulation of endotracheal tube to the patients caused serious damage and fear to patients psychological,it also influence the postoperative recovery of patients.Therefore, looking for a small effects of respiratory system, and can make patients calm and reduce pain drugs, is a clinical significance.OsCAX3root, nose, pharyngeal and laryngeal.These parts are respiratory and senior vital central area and are rich in life blood vessels, so the surgery is more delicate, the surgeon’s control is on a small scale, the operation time is extended, blood loss in patients is relatively more, it increased difficulties for an anesthesiologist in perioperative management of patients.These more or less influence the postoperative recovery of the patients.If there is a drug, it can steady blood flow dynamics, reduce the dosage of anesthetic drugs, make patients awake rapidly, decrease postoperative complications. It is not only convenient for anesthesia management, but also bring patients tangible benefits.Patients waking after anesthesia, operation trauma pain will continue for quite a long time. If you don’t have good measures of analgesia, their pain is not conducive to the medical management, but also affect patients recover. It will reduce the treatment effect. Ever we use opioid analgesia most, but this kind of drugs most have respiratory inhibition effects, using for a long time with addiction, and that this kind of drugs are limited use. Therefore, it is necessary to seek a kind of good postoperative analgesics.Reports indicated that, in clinical intensive care use a new type of central a2-adrenaline receptor agonist drugs. Hydrochloric acid dexemedetomidine (Dexmedetomidine, DEX). It has sedation effect, can reduce the critical patients fidgety, still can protect myocardium, reduce oxygen consumption of brain functions. However, the relevant reports about dexmedetomidine in the awake tracheal intubation, maintain in anesthesia, postoperative analgesia is little. The experiment research dexemedetomidine using for oral and maxillofacial surgery patients for awake tracheal intubation effects and safety, and maintain in the effects of general anesthesia and the influence for the awakening, the effects of dexmedetomidine with flurbiprofen axetil in postoperative analgesia and the curative effects of decreasing complications postoperation.The experiment1: clinical research of dexmedetomidine in oral and maxillofacial surgery for awake fiberoptic bronchoscopy tracheal intubationObjective: to discuss the method and security of DEX in the nasal awake fiberoptic bronchoscope in tracheal intubation.Methods: choosing40oral and maxillofacial tumors patients in general anesthesia, male20cases, female20cases, ASA Ⅰ～Ⅱ, age18to55years old, weight is in45to70Kg.When patients in the operating room, monitoring the electrocardiogram, heart rate, pulse oxygen saturation, blood pressure and brain bispectral index. Then, establish vein circuit. Randomly divided into A group: DEX join48ml0.9%of sodium chloride injection into the preparation for concentration4μg/ml solution,trace pump application for pump injection DEX1μg/Kg; In the process of infusion HR <50times/min, give atropine0.3～0.5mg correct; When patients OAA/S score to3points, implement needle cricothyroidotomy,2%lidocaine tracheal mucosal surface anaesthesia, the nasal awake fiberoptic bronchoscopy tracheal intubation.Group B: application of midazolam2mg and fentanyl0.05mg. When patients OAA/S score to3points, implement needle cricothyroidotomy,2%lidocaine tracheal mucosal surface anaesthesia, the nasal awake fiberoptic bronchoscopy tracheal intubation.If the patient is not up to3points score calm, continues to additional midazolam2mg and fentanyl0.05mg, until it reaches3points, the implementation of these measures. Waiting for patients stable (T0), two groups of patients alert calm (observer s assessment of alertness/sedation, OAA/s) score to3points (T1), tracheal intubation success (T2) and immediately after tracheal intubation5min (T3), record BP、HR、SpO2and BIS. T0and T3in plasma norepinephrine (norepinephrine, NE) and epinephrine (epinephrine, E) concentration,T1DEX dose. Through the observation of the vital signs of patients, evaluation the role and security of DEX in the nasal awake intubation fiberoptic bronchoscope. To observe the changes of vital signs of patients, evaluating the effects and security of dexmedetomidine using for nasal awake fiberoptic bronchoscopy tracheal intubation.Results: compared with group B: the heart rate of group A in the T1, T2and T3are reduced significantly (P <0.05), and MAP in T2significantly reduced, SP02in the Ti, T2are higher than the group B (P <0.05), BIS value without significant difference in different time points (P>0.05), Two groups of NE E level increased significantly in T3moments, but A group was significantly lower than the group B (P <0.05).Conclusions: dexmedetomidine using for the patients of nasal awake fiberoptic bronchoscopy tracheal intubation, patients without respiratory inhibition, hemodynamic is stable in the process of tracheal intubation. Therefore, dexmedetomidine using for the patients of nasal awake fiberoptic bronchoscopy tracheal intubation is safe and effective.The experiment2: to observe the effects of dexmedetomidine with remifentanil and sevoflurane in oral and maxillofacial surgery.Objective: Aims to observe the effects and safety of DEX composite remifentanyl and sevoflurane in oral and maxillofacial surgery in the general anesthesia.Methods: choosing40oral and maxillofacial tumors patients in general anesthesia, male20cases and female20cases, ASA Ⅰ～Ⅱ, age18to55years old, weight is in45to70Kg. Randomly divided into dexmedetomidine-remifentanil-sevoflurane group (group A) and remifentanil-sevoflurane group (group B). Preoperative patients ban diet8h, preoperative30min0.5mg muscle injection atropine, using Philips monitoring ECG, HR, BP and Sp02. Open lower limb vein, face masks to oxygen in advance. Two groups of patients are using midazolam2mg, fentanyl4～5μg/Kg, propofol2～2.5mg/Kg, vecuronium ammonium6～8mg. tracheal intubation complete for mechanical ventilation, tidal volume according to8mL/Kg. Intraoperation maintain the remifentanyl0.1～0.2a g/Kg/min, inhaled sevoflurane in1%～3%, given the DEX0.4～0.7a g/Kg/h constant speed infusion, and the control group is given the same doses of saline. Two groups of patients intraoperation MBP maintain in55to65mmHg, maintain the BIS in value between50and65, according to the life signs of patients and the stimulus of surgery during the operation to adjust the size of remifentanyl and sevoflurane. Before the end of20min operation discontinued DEX, before5min discontinued sevoflurane and remifentanyl.Intraoperation every20min record at the end of the exhale sevoflurane concentration, and finally take the average as intraoperative sevoflurane maintain concentration.By comparing the two groups of patients intraoperation blood flow dynamics (MAP, HR) changes and the usage amount of remifentanil per hour and at the end of the exhale sevoflurane concentration to evaluate the anesthesia curative effects of dexmedetomidine.Results: remifentanil every hour usage and at the end of the exhale sevoflurane concentration of group A is less than that group B (P <0.05), compared with group B, heart rate of group A in T1, T2and T3is lower(P <0.05), MAP of group A in T1, T2and T3also is lower(P <0.05).Conclusion: using dexmedetomidine in anesthesia, it can reduce the stress reaction of surgical stimulation, and slow down the heart rate, lower blood pressure, reduce the total amount of the anesthetic drugs to use. So postoperative patients awake quickly, drawing tube time is shortened, patients are quiet and comfortable, no postoperative restless. The incidence of nausea and vomiting and chill reduce. It indicated that maintain effects of dexmedetomidine in anesthesia is exact, and patients awake quickly, less postoperative complications, It is a good anesthesia maintain medicine.The experiment3: to research the effects of dexmedetomidine using for analgesia in oral and maxillofacial surgery Objective: to evaluate the effects of dexmedetomidine with sufentanil using for analgesia in oral and maxillofacial surgery postoperative patientsMethods: choosing40oral and maxillofacial orthognathic surgery patients in general anesthesia, male20cases and female20cases, ASA Ⅰ～Ⅱ, age20to55years old. Randomly divided into sufentanil group (group S) and dexmedetomidine with sufentanil group (group SD). After patients awake, immediately give analgesic pump analgesia. Sufentanil group give sufentanil50μg+ondansetron8mg and physiological saline dilution to100ml analgesic pump. Dexmedetomidine with sufentanil (group SD) postoperative analgesia give dexmedetomidine for200μg with sufentanil50μg with saline dilution to100ml in analgesic pump. Two groups use the background of analgesia pump dose for2ml/h, a single loading doses0.5ml, continuous infusion48h. To observe two groups of postoperative vital sign changes, pain score and adverse reaction, to evaluate postoperative analgesia effects of two groups.Results: compared with group S, in T1, T2and T3moment group SD MAP and heart rate are lower (P <0.05), two groups of patients underwent the12h,24h the dosage of sufentanil, PCIA12h press number SD group is less than that of group S (P <0.05), group S postoperative nausea in10(40%), vomiting in7patients (35%); SD group sick3patients (15%), vomiting2cases (10%), and SD group of nausea and vomiting rates were significantly lower than S group (P <0.05), but group S bradycardia0example, the SD group bradycardia5cases (25%), and SD group significantly more than S group (P <0.05).Conclusions: DEX joint sufentanil can not only reduce sufentanil dosage, still can reduce sufentanil used for postoperative analgesia caused nausea, vomiting, sleepiness side effects, patients in the experiment failed to show any sleepiness and respiratory inhibition phenomenon, DEX joint sufentanil used for postoperative analgesia is safe and effective. |
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