A Comparative Study Of The Effect Of Dexmedetomidine And Propofol On Hypertensive Patients Extubation Under Deep Anesthesia

Objective: To compare the cardiovascular changes and complications when given dexmedetomidine and propofol in hypertensive patients extubation under deep anesthesia during elective surgery under general anesthesia,discuss the best method extubation under deep anesthesia in hypertensive patients.Methods: Choose 60 hypertensive patients with elective surgery under general anesthesia,ASA?-?,age was 40-65 years old,BMI<30kg / m2,preoperative blood pressure controled less than or equal to 150/90 mmHg.All patients had no seriously heart disease,brain disease,liver disease,or kidney disease,except patients who estimated with difficult intubation or obese patients and patients with preoperative severe bradycardia,atrioventricular block.All patients also had no history of allergy of dexmedetomidine or propofol and other anesthetic drugs.Preoperative examinations were completed and normal.Continuous intravenous infusion of dexmedetomidine and propofol was stopped immediately and symptomatic treatment when bradycardia ?lower blood pressure and other adverse reactions occurred.The patients were randomly divided into two groups,30 cases in each group.Group D was continuoued intravenous infusion with dexmedetomidine and Group P was continuoued intravenous infusion with propofol.The two groups of patients were inductioned and maintained with intravenous drugs during anesthesia.BIS was used to monitor the depth of anesthesia.Anaesthesia was induced with midazolam,etomidate,cisatracurium and sufentanyl,anesthesia maintained with propofol,cisatracurium and remifentanil besylate.Stoppumping cisatracurium twenty minutes before the end of surgery.Use atropine and neostigmine antagonistic muscle relaxants at the end of surgery.Group P stop infusion remifentanil and continue infusion of propofol;Group D stop infusion propofol and remifentanil,only dexmedetomidine was infused.Two groups of patients with spontaneous breathing recovery,tidal volume(VT)> 350 ml,respiratory rate(RR)<20times/min,ensuring spontaneous breathing oxygen saturation(SpO2)maintained>90%.Two groups of patients with endotracheal tube suctioning no significant choking or mild reactions,stop all anesthetics drugs,removal of oral and respiratory secretions and pull out extubation,after extubation inhalation oxygen with a mask,in case of SpO2<90% hold the lower jaw or placing oropharyngeal tool immediately.Systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP)and heart rate(HR)were monitored and recorded after entering the operating room(T1),at the end of surgery(T2),before extubation(T3),the period of extubation(T4),5min after extubation(T5),10 min after extubation(T6),20 min after extubation(T7),30 min after extubation(T8);the duration of surgery;the situation of anesthesia recovery: extubation time(time from the end of surgery to extubation),recovery time(time of open eyes after extubation).The incidence of sore throat,choking out glossocoma,irritability,laryngospasm or cough and airway spasm after extubation time.Results:1.General information and operation condition on the two groups had no significant difference(P>0.05);2.SBP,DBP and MAP were compared between the two groups during the period of extubation.There was no significant fluctuations at T3-T8,lower than T1.The two groups of patients comparison of HR at T3-T8 Group D stay stable compared with P group fluctuations significantly,the difference between the groups was statistically significant(P<0.05).Comparison of SpO2 in T5 decreased slightly,the difference between the two groups was statistically significant(P<0.05);SBP,DBP,MAP,SpO2 between the two groups showed no significant difference(P>0.05);3.The comparison of extubation recovery time:There was no difference comparedbetween two groups in extubation time.However the awake time after extubation in Group P was slightly longer than Group D,the difference was statistically significant(P<0.05);4.Complications after extubation: There were two patients occurred glossoptosis and three cases restlessness in Group P after extubation.One of the restlessness patients have a difficult on inhalation oxygen with mask,however Group D with no one occurred glossoptosis,the two groups were compared with the incidence of complications was significantly(P>0.05);No one has cough during extubation in the two groups,so there was no statistical significance(P>0.05).Conclusion: General anesthesia patients with hypertension use dexmedetomidine and propofol extubation under deep anesthesia can effectively eliminate the extubation cardiovascular reaction,however dexmedetomidine had better effect on postoperative extubation and recovery period to maintain blood pressure and heart rate stability and the complications after extubation,Therefore dexmedetomidine has an advantage over propofol in terms of extubation under deep anesthesia.