| Objective: To observe the safety and effectivity of etomidate and propofol combined with dexmedetomidine during fiberoptic bronchoscopy in children,The general anesthesia is the best way of anesthesia during pediatric bronchoscopy,however,anesthesia drugs have more limitations in child.Howto control the depth of anesthesia and how to make a rational combination of narcotic drugs are still a challenge for anesthesiologist.In this study,we investigate the clinical effect of etomidate and propofol combined with dexmedetomidine anesthesia during fiberoptic bronchoscopy in children,evaluate the safety and efficacy of etomidate and propofol combined with dexmedetomidine anesthesia during fiberoptic bronchoscopy in children,and to provide clinical reference for optimal anesthesia scheme of pediatric bronchoscopy.Methods:60 patients undergoing elective fiberoptic bronchoscopy,who had no specific diseases(ASA grade I-II)and had no abnormalities in preoperative liver function,blood,and electrocardiogram examination,enrolled in the study and divided into three groups randomly:etomidate compound with dexmedetomidine group(ED group),etomidate and propofol compound with dexmedetomidine(EPD group),propofol compoundwith dexmedetomidine group(PD group),20 cases in each group.The included children were taken into the waiting room after anesthesia,were given midazolam 0.05mg/kg and penehyclidine 0.01mg/kg.After they were quite,were given lidocaine 4mg/kg ultrasonic atomizing inhalation at 10 min before the examination,at the same time,intravenous drip of 1ug/kg dexmedetomidine,and ED group:intravenous injection of 0.1ug/kg sufentanil and 0.2-0.6mg/kg etomidate,intravenous infusion of 0.4-1.2mg/kg/h etomidate to maintain.EPD group:intravenous injection of 0.1ug/kg 0.15mg/kg sufentanil,0.5-1.5mg/kg etomidate and 0.5-1.5mg/kg propofol,intravenous infusion of0.2-0.6mg/kg/h etomidate and 3-6mg/kg/h propofol to maintain.PD group:intravenous injection of 0.1ug/kg 0.15mg/kg sufentanil and 1.5-3mg/kg propofol,intravenous infusion of 6-12mg/kg/h propofol to maintain.The BIS of all patients were maintained 40-65.The relevant fiberoptic bronchoscopy was performed by the same doctor.Observation index: 1.Observe the general condition of the children.2.The number of adverse events,such as body movement,cough,respiratory depression and injection pain,were observed during the observation.3.observe and record children’s vital signs at different times(MAP,HR,Sp O2): after quiet(T0),pump after dexmedetomidine(T1),induce(T2),bronchoscopy into glottal(T3),bronchoscopy to reach carina(T4),bronchoscopy to bronchial(T5).4.The time of induction of anesthesia,the time of postoperative recovery and the time of operation were recorded.5.Records of postoperative nausea,vomiting and irritability,evaluation of anestheticeffect,and the evaluation of doctors’ satisfaction.Results:(1)general comparison: there was no statistical difference between the age and weight of the three groups(P>0.05).(2)induction time: group ED:(52.3 ±12.1)s,group EPD:(51.6 ±13.2)s,group PD :(52.6±12.4)s,there was no significant difference between three groups(P>0.05).(3)operative time: group ED:(28.3±6.5)min,group EPD:(29.1 ±7.2)min,group PD:(28.5±6.8)min,there was no significant difference between three groups(P>0.05).(4)recovery time after operation: group ED:(9.3 ± 5.9)min,group EPD:(9.6 ± 5.2)min,group PD:(9.2±6.1)min,three groups had no statistically different(P>0.05).The vital signs: MAP:at T0 time,there were no significant differences among the three groups(P>0.05);at T1 time,MAP in three groups were decreased(P<0.05);in comparison of T1 time with T2 moment,MAP in PD group and EPD group were decreased,but MAP in PD group decreased more than that of EPD group(P<0.05);T3-T5 time compared with T0 time,MAP in group ED increased(P<0.05),at T3-T5 time,MAP in ED group increased more than that of PD group and EPD group at the same time,and there were significant differences(P<0.05).(2)HR: three groups slowed down to some extent at T1 time compared with T0 time(P<0.05);T2 time compared with T1 time,HR in PD group decreased;at T3-T5 time compared with T1 time,HR in ED group was higher.The HR in group ED at T3-T5 time was higher than that of PD and EPD group at the same time(P<0.05).(3)Sp O2:compared with the T1 moment,the Sp O2 of the PD group at T2 time was reduced(P<0.05);at T2 time,Sp O2 in PDgroup was lower than that of EPD,ED group(P<0.05);at T3-T5 time Sp O2 in PD group was lower than that of EPD,ED group at the same moment(P<0.05).The occurrence of adverse reactions during operation: 1 myoclonus: ED group occurred in 3 cases(incidence of 15%),EPD group occurred in 1 cases(incidence of 5%),PD group occurred in 1 cases(incidence of 5%),the three groups had no statistical difference(P>0.05).The incidence of cough: ED group occurred in 5 cases(incidence of 25%),EPD group occurred in 0 cases(incidence of 0%),PD group occurred in 1 case(incidence of 5%),ED group was higher than that of PD group and EPD group(P<0.05).The body movement: the ED group had 1 case(incidence of 5%),EPD group occurred in0 cases(incidence of 0%),PD group occurred in 0 cases(incidence of 0%),the three groups had no statistical difference(P>0.05).The inhibition of respiration:ED group occurred in 1 cases(incidence of 5%),EPD group occurred in 2cases(incidence of 10%),PD group occurred in 8 cases(incidence of 40%),PD group was higher than that of ED group and EPD group(P<0.05).The injection pain occurred: ED group occurred in 1 case(incidence of 5%),EPD group occurred in 1 case(incidence of 5%),PD group occurred in 8 cases(incidence of 40%),PD group was higher than that of ED group and EPD group(P<0.05).The adverse reaction and postoperative.Postoperative restlessness: three groups were not observed in the occurrence of postoperative restlessness;postoperative nausea and vomiting in group ED occurred in 6 cases(incidence of 30%),EPD group occurred in 1 cases(incidence of 5%),PD group occurred in 1 cases(incidence of 5%),PD group was higher than that of ED group and EPD group(P<0.05).The evaluation of anesthesia: PD group and EPD group anesthesia efficacy evaluation was higher than that of ED group(P<0.05).the satisfaction of doctors: PD group and EPD group anesthesia efficacy evaluation was higher than that of ED group(P<0.05).Conclusion: The etomidate combined with propofol and dexmedetomidine has advantages in pediatric bronchoscopy,with more stable vital signs,lower intraoperative and postoperative incidence of adverse events,the better anesthesia,the higher doctor satisfaction,is a kind of ideal anesthesia method for pediatric bronchoscopy. |
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