| Background Anesthesiologists often encounter short operations in clinical practice,for which we can usually simply use sedative and analgesic anesthesia.There are many experiences of the combination of drugs on this type of anesthesia in previous studies.But with the continuous development of new drugs,we hope to enhance the quality of this anesthesia by using the advantages of new drugs.The advantages of dexmedetomidine and remifentanil in clinical applications are considerable,but taking into account its adverse reactions,they are less applied in sedative and analgesic anesthesia.In this study,we used these two drugs in combination and observed the patients’ vital signs to explore the efficacy and safety of sedative and analgesic anesthesia in different operative positions.The bispectral index(BIS)、nasal PETCO2 were respectively used to monitor the intraoperative sedative depth and respiratory depression during the surgery.We hope this study will provide a new way for drug combination in sedative and analgesic anesthesia and become a basis for the combined use of dexmedetomidine and remifentanil in this kind of anesthesia,which can offer a better anesthesia experience for patients undergoing surgery.Methods Sixty female patients,American Society of Anesthesiologists physical status I or II,scheduled for elective plastic operations under sedative and analgesic anesthesia combined with local anesthesia were divided into two groups according to their surgical positions:supine group(n=30)and prone group(n=30).All patients received IV dexmedetomidine(DEX)1 μg/kg over 15 min followed by 0.4-0.7 μg/kg/h infusion.Both groups were administered IV midazolam 0.04mg/kg and a continuous infusion of remifentanil of 0.1gg/kg/min at the beginning of anesthesia.Heart rate(HR),mean arterial pressure(MAP),pulse oximetry(SpO2),incidences of respiratory depression,bispectral index(BIS)and Ramsay sedation scores(RSS)were recorded at the following time points:before anesthesia(To),5 min after induction with midazolam(Ti),10 min after induction of midazolam(T2),immediately after induction with DEX(T3),the beginning of local anesthesia(T4),the beginning of surgery(Ts),30 min after anesthesia induction(T6),60 min after anesthesia induction(T7),immediately after turning off DEX infusion(Ts),the end of surgery(T9).Incidences of apnea,oxygen supplementation by facial mask and thrusting the jaw,frequencies of body movements and additional rescue drug administrations were also recorded.After surgery,patients were sent to the PACU where postoperative pain management were conducted.Incidences of side effects including nausea,vomiting and respiratory depression were all recorded in PACU.Recall of events during surgery,the visual analogue scales(VAS)for pain,the satisfaction levels of patients and surgeons were also assessed.Results Two groups of patients got through the surgical period safely and smoothly,no significant differences were found in MAP,SpO2,incidences of respiratory depression,BIS,RSS scores at any time point we choose to observe between two groups(all P>0.05).There were no significant differences in frequencies of body movements and additional rescue drug administrations during surgery between groups(all P>0.05).Neither were recall of events during surgery,the visual analogue scales(VAS)for pain and the satisfaction levels of patients and surgeons after surgery(all P>0.05).The HR at time points of T0,T1,T2 in prone group were significantly higher than those in supine group(all P<0.05).Compared with the supine group,the incidences of apnea,oxygen supplementation by facial mask and thrusting the jaw in prone group were significantly lower.Conclusion In this clinical study,we found that sedative and analgesic anesthesia is effective and safe for patients undergoing short plastic surgeries in different surgical positions.And compared with supine position,patients with prone position has a lower incidence of upper airway obstruction during the surgery.The surgeons and patients both have considerable satisfaction. |
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