Clinical Study Of Dexmedetomidine Hydrochloride Used In Anesthesia And Postoperative Analgesia For Caesarean Section

In recent years, with the improvement of people’s quality of life, more and more maternals choose cesarean delivery. Obstetric anesthesia has become the focus of clinical anesthesia, and Combined Spinal-Epidural Anesthesia(CSEA) are commonly used for caesarean section.Dexmedetomidine(Dex)is a highly selective alpha-2 agonist with analgesic and sedative effects but does not cause respiratory depression, the ratio of α2: α1 for dexmedetomidine is 1620:1.Part 1 The influence of Dexmedetomidine on maternals and newborns used for caesarean section via intrathecal injectionObjective: To evaluate the effect of dexmedetomidine used intrathecally in maternals undergoing caesarean section.Methods: Eighty patients(ASAⅠ-Ⅱ), aged 22-34 yr, weighting 50-71 kg undergoing cesarean delivery operation under CSEA were randomly divided into two groups to receive Dex 5μg(group D,n=40)or Saline solution(group C,n=40). Mean arterial pressure(MAP), heart rate(HR), respiration rate(RR), saturation of pulse oximetry(Sp O2) were recorded continuously, and Visual analogue scale(VAS score), Ramsay score and Apgar score were also recorded at each points, and the adverse effects were recorded during operation. Neonatal cord blood gas analysis was taken rapidly and The serum concentration of catecholamine are determined by ELISA.Results: Compared with group C,the VAS score of group D was significant lower at T4(p<0.05); The incidence rates of Chill, Nausea, vomit of group D were lower than that in group C(p<0.05); Our study revealed that the concentration of lactic acid(Lac),Epinephrine(EPI) and Norepinephrine(NA) of group D were obvious lower than that in group C(p<0.05); MAP, HR, SPO2, Apgar score and Ramsay score did not show statistical difference between the two groups.Conclusions: Dexmedetomidine used for cesarean section via intrathecal injectioncan enhance the analgesic effect, and reduce the incidence of Chill, Nausea, vomit during operation.Part 2 The evaluation of Dexmedetomidine used for Patient-controled extradural analgesia(PCEA) a after cesarean sectionObjective: To evaluate the effect of dexmedetomidine used for PCEA after cesarean section, and observe the influence on maternals and newborns.Methods: Eighty patients(ASAⅠ-Ⅱ), aged 19-38 yr, weighting 55-82 kg after cesarean delivery operation under Combined spinal-epidural anesthesia were randomly divided into two groups,group D(n=40) receive 0.15% Ropivacaine plus Dex 1μg.kg-1and group C(n=40) 0.15% Ropivacaine plus Morphine 5mg. Vital signs of maternals and newborns, the satisfaction of maternals, VAS score Ramsay score and the adverse effects were record at 2h,6h,12 h,24h,48 h after surgery.Result: The VAS score of group D were significant lower at 6h-48h(p<0.05);and the Ramsay score of group D was lower than that in group C at 12 h after surgery(p<0.05); Compared with group C,the incidence rates of Nausea, vomit, Pruritus of group D were decreased obviously(p<0.05); The satisfaction between the two groups had no significant difference( p > 0.05), but the incidence of “great satisfaction” was higher in group D(p<0.05); There was no difference between the two groups according to hemodynamic data.Conclusions: Dexmedetomidine can be used for postoperative analgesia after cesarean section, and it can reduce the incidence rate of some adverse effects, increase the satisfaction of maternal.