| Chapter 1 The efficacy and safety of intranasal dexmedetomidine in vocal cord surgery with suspension laryngoscopeObjective:To evaluate the efficacy and safety of intranasal dexmedetomidine on perioperative sedation and hemodynamics in vocal cord surgery with suspension laryngoscope.Preoperative sedation satisfaction and mask acceptance were observed in three groups.Methods : Sixty patients undergoing vocal cord surgery with suspension laryngoscope were randomly divided into experimental group and control group,30 cases in each group.In the experimental group,intranasal dexmedetomidine 0.5 ?g/kg was given 40 min before anesthesia,equivalent normal saline for control group.The hemodynamic changes were recorded before(T0)and after anesthesia induction(T1),intubation(T2)and extubation(T3).The extubation time,postanesthesia care unit(PACU)stay,and the incidences of agitation,nausea and vomiting were recorded after surgery.Result: HR(heart rate)and MBP(mean arterial pressure)was significantly lower on T1 than T2 and T3 in both groups(P <0.01).In experimental group,HR and MBP was significantly lower on T2 and T3 than the control group(P <0.01).There was not statistically significant in SPO2 between two groups(P> 0.05).The sedation satisfaction in experimental group were significantly higher than those in control group before anesthesia induction(P < 0.05).The incidence of postoperative agitation and nausea and vomiting in experimental group were significantly lower than those in control group(P <0.05).There were no significant differences in the extubation time PACU stay between experimental group and control group(P>0.05).Conclusion:D Intranasal dexmedetomidine 0.5?g/kg is safe and effective for vocal cord surgery with suspension laryngoscope.It can stabilize perioperative hemodynamic,increase the preoperative sedation satisfaction and decrease the incidence of agitation,nausea and vomiting without lengthening PACU retention time.Chapter 2 The different doses of dexmedetomidine by intranasal administration in vocal cord surgery with suspension laryngoscopeVOBJECTIVE:To observe the effects of different doses of dexmedetomidine on thehemodynamics,stress response and the duration of extubation and the effect of restlessness on the duration of anesthesia during the perioperative period of vocal cord surgery,The best fit dose of diazepam in the vocal cord surgery under the support of the laryngoscope.Methods:Fifty patients with vocal cord polyp excision were randomly divided into five groups: normal saline group(N group),low dose group(group D1),right middle dose group(D2 group),Dexterated high dose group(group D3)and remifentan group(group R).N group and R group were injected with 0.9% saline,D1,D2 and D3 by intranasal instillation of 0.25 ?l / kg,0.5 ?l / kg,1.0 ?l / kg Microphone.Anesthesia induction: N group,D1,D2 and D3 group propofol 2mg / kg,fentanyl 2ug / kg pump injection,until the patient consciousness disappeared after the injection of rocuronium ammonium 0.9mg / kg;R group of propranolol Phenol 2mg / kg,remifentanil 2ug / kg pump injection,until the patient consciousness disappeared after the injection of rocuronium ammonium 0.9mg / kg.BIS ? 50 s after the maintenance of 5s,tracheal intubation mechanical ventilation.HR values ??and MAP values ??were recorded at four time points(T0),intubation(T1),posterior(T2),extubation(T4),and serum adrenaline and norepinephrine And the amount of propofol was recorded.The degree of pain was scored at 5 min,10 min,20 min and 30 min after extubation.Result:1.HR comparison between five groups of patientsThere was no significant difference in HR between the T0 and T1 time points(P>0.05).The HR value of each group was significantly higher than that of T1 at the T2 time point,and the N group was the most obvious(P <0.05).There was significant difference between the N group and the D2,D3 and R groups(P <0.05),but there was significant difference between the T2 group and the control group(P <0.05);T4 at the time point,compared with T3,the HR value of each group were increased,which,N group and R group increased the most obvious,R group was slightly higher than the N group,R group and N group and D2,D3 group(P <0.05).2.MAP comparison of five groups of patientsThere was no significant difference between the two groups(P> 0.05).There was no significant difference between the T2 group and the control group(P <0.05).There was no significant difference between the two groups(P> 0.05)(P <0.01).There wassignificant difference between the N group and the other group(P <0.01).There was significant difference between the N group and the control group(P <0.01)(P<0.05).There was a significant difference between the N group and the D2 group(P<0.05).The results are shown in Table 3.3.Serum E and NE levels on T0,T2Compared with T0,the levels of E and NE in D1,D2,D3 and R groups were significantly decreased at T2 time points,and the level of E in N group was significantly higher than that in T0 group.Compared with N group,serum E levels in D1,D2,D3 and R groups were significantly decreased at T2 time points,the difference was statistically significant(P <0.05),and the serum NE levels in D2 and D3 groups were significantly decreased at T2,The difference was statistically significant(P <0.05 or 0.01).4.Each group of patients after extubation pain scoreAt 10 min and 20 min after extubation,the pain scores of D1,D2 and D3 were significantly different from those of N group,and the pain scores of the other four groups were significantly lower than those of N group(P <0.05).The pain scores showed a steady trend between 5 and 30 min after extubation in D2 and D3 groups,while the pain scores of R group increased in this time interval,20 min and 30 min after extubation,Compared with R group,the pain score was significantly different(P <0.05).Conclusion:Dexmedetomidine nasal administration in the support laryngoscope under the vocal cord surgery,can make the patient's hemodynamic stability,of which 0.5ug / kg deemethomidine better effect,which can stabilize the patient hemodynamics,And will not make the patient postoperative recovery delay.Thus,0.5 ug / kg of dexmedetomidine administered by nasal administration deserves clinical promotion and use in support of laryngoscopy. |
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