| PurposeThe different infusion rate of dexmedetomidine was evaluated for the hemodynamics, depression of stress, sedative and analgesic effects, adverse drug reactions. It was to explore more safe and effective neonatal anesthesia scheme.Method183 patients with neonatal digestive tract malformation were recruited. The patients were randomly divided into three groups, including 65 cases of groupA(observation),57 cases of group B(observation), and 61 cases of group C(control). Anesthesia method was followed:the patients breathed sevoflurane ranged from 1% to 3% as they were awake, then 0.2mg/kg of cisatracurium besilate and 1?2?g/(kg·h) of remifentanil were carried out intravenous injection after sleep. In order to maintain anesthesia,1%?2% of sevoflurane was also inhaled,20?g/(kg·h) of remifentanil and 0.15mg/(kg·h) of cisatracurium besilate were injected by pump. But it was not same for the three groups during the maintainment anesthesia,0.5 mg/(kg·h) of dexmedetomidine was extra used for group A,0.75 ?g/(kg·h) of dexmedetomidine for group B, by contrary, physiological saline for control C. The vital signs, sedation and pain score were monitored and recorded in the process of operation. The narcotic effects would be compared among the three groups.Results1. General data There were no statistical significances in the age, weight and operation time among the three groups (P>0.05).2. Hemodynamics W wave trend was shown for heart rate during anesthesia time among the three groups. The heart rate of group B was lower than that of control during T2?T5 (P<0.05). The heart rate of group A was also lower than that of control at the times of T2, T4 and T5 (P<0.05). At the T5,the heart rates of group A, B and control were 135.75±4.32 times/min,134.51±4.57 times/min and 149.56±5.62 times /min, respectively. There were significant differences in the systolic pressure(SBP) among the three groups(P<0.05). It was shown that SBP steadily decreased from the figure between group A and B, however more obvious fluctuation for the control. In surgery, the diastolic blood pressure(DBP) in the control group slightly increased, relative stabilization in the group A, lower in the group B, there were significant differences(P<0.05). There was interaction between the change of DBP and operation time.3. Level of adrenaline The levels of adrenaline of three groups increased with the time from T1 toT4, sharply rose at the time of T5. They were 146.10±49.68mol/L, 159.34±51.25mol/L and 171.27±52.65mol/L, respectively. The levels of group A and B were lower than that of control (P<0.05), and the level of group A was also lower than group B (P<0.05).4. Score of sedation and analgesia There were statistical significances in the bispectral index(BIS) among the different times. From T2 to T5, the values of BIS of group A and B were lower than that of the control (P<0.05). At the time of T3, the values of BIS of group A, B and control were 46.72±1.14,42.70±1.31 and 53.56±1.32, respectively. After operation, there were significant differences in the score of sedation (face, legs, activity, crying, consolability, FLACC) (P=0.038) among the groups. From T8 toT10, the values of FLACC between A and B were lower than that of the control (P<0.05), at the time of T10, the values of FLACC were 1.27±0.51,1.02±0.15 and 1.82±1.21, respectively (P<0.05).5. Adverse reactions There were respiratory depression, nausea and vomiting among the three groups. The adverse reaction rates of group A, B and control were 6.15%,15.79% and 32.79%, respectively.Conclusion(1) Dexmedetomidine could be used as an auxiliary anesthesia in the operation of neonatal digestive tract malformation. It can maintain the stability of blood flow dynamics, enhance the effect of sedation and analgesia, effectively inhibit the levels of Cor and E in the serum, decrease stress response and postoperative restlessness of anesthesia intubation and surgical trauma, and reduce adverse reactions. So it would be a desired auxiliary anesthesia for neonatal surgery.(2) The dose at 0.5?g/(kg·h) of dexmedetomidine is appropriate, up to 0.75?g/(kg·h), some side effects happened, such as heart rate slowing and BIS value dropping. |
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