Effect Of Dexmedetomidine On Agitation After General Anesthesia In Patients With Wilson’s Disease

Objective Wilson’s disease is often combined with nervous system impairment,mental symptoms and other clinical manifestations because of the disorder of copper metabolism or the lesion of liver,kidney,brain and other extensive organs.Patients with splenic hyperfunction experienced a increase effective in counts of platelet or leukocyte and improving liver function by splenectomy.Studies showed that dexmedetomidine combined with general anesthesia had effects of reducing the requirement of anesthetic and decreasing emergence agitation.The purpose of this study to investigate the effect of dexmedetomidine on preventing agitation after general anesthesia in Wilson’s disease patients.Methods Sixty ASA physical status classПor classШ,aged 18-50 yr,undergoing elective splenectomy patients were randomized into two groups of 30 each,using computer-generated random numbers.Two groups of patients were preoperative fasting,no smoking,and 30 min before surgery to give luminal sodium 0.1 intramuscular injection.The changes of electrocardiogram（ECG）and heart rate（HR）,non-invasive blood pressure（NIBP）and mean arterial pressure（MAP）were measured before and after admission.Arterial oxygen saturation（SpO2）and bispectral index（BIS）.All patients were intravenous infusion of sodium lactate Ringer’s solution at a rate of 8ml·kg^-1·h^-1.Dexmedetomidine 0.4μg/kg then 0.4μg·kg^-1·h^-1 continuous infusion until the splenectomy in Group D but only normal saline in Group C.Intraoperative maintenance of BIS value of 40 to 60 and P_ETCO2（end-tidal carbon dioxide partial pressure）in 35⁴5 mmHg,on demand additional cisatracurium.Immediately after administration of remifentanil and propofol,intravenous tropisetron 2 mg and flurbiprofen axetil injection 1.5 mg/kg.Patients with swallowing reflex recovery,spontaneous breathing frequency>12 times/min,tidal volume>6 ml/kg,offline after SpO2>95%,and BIS value>90 for the removal of tracheal tube standards.Heart rate<50 times/min intravenous injection of atropine sulfate injection 0.25 mg.All patients were removed from the tracheal tube and sent to the PACU.Mean arterial pressure（MAP）,heart rate（HR）and pulse oxygen saturation（SpO₂）before the administration（T₀）,15 min after the administration（T₁）,1 min after intubation（T₂）,before extubation（T₃）and 3 min after extubation（T₄）were recorded by another anesthesiologist who blinded to the pretreatment.In addition,relevant adverse effects and time of the patients transferred from PACU were also record.Measurement data used two independent samples t test,and count data usedχ² test or Fisher exact probability method.Results There was no significant difference between the two groups in the basic data,with good comparability.Significant stability of MAP or HR was found in Group D at T₁-T₄ and decrease in Sedation-Agitation Scale（SAS）at T₃-T₄ comparing with Group C（P<0.05,P<0.001）.There was only one case with bradycardia appeared in Group C but eight in Group D（P<0.05）.Furthermore,time of the patients transferred from PACU was longer in Group C（P<0.001）.Conclusions Dexmedetomidine combined with general anesthesia could bring more stable hemodynamics,lower incidence rate of postoperative agitation and shortening the staying period in PACU.