Effect Of Different Dosage Regimens Of Dexmedetomidine On Emergence Agitation During Recovery Period After Operation In Department Of Neurosurgery

Objective:Comparison of the three dosing regimens of dexmedetomidine on prevention of emergence agitation during recovery period after operation in department of neurosurgery.Methods:Choose ASA classⅠorⅡelective general anesthesia downlink neurosurgery patients 160 cases,using computer generated random number table method divided the patients into four groups（n=40）:control group（D₀ group）and experimental group（D₁ group、D₂ group、D₃ group）.After the patient entered the operating room,the venous access was opened and routine vital signs were monitored and Narcotrend monitored.Anaesthesia induced the use of propofol 1.5-2.0mg/kg,fentanyl 4ug/kg,cis-aquamonium 0.15mg/kg,and the mechanical ventilation was completed by the endotracheal intubation when the muscle pine was satisfied.The anesthetic maintenance was carried out with propofol 4-6mg·kg^-1·h^-1,cis-aquamonium 0.1-0.2mg·kg^-1·h^-1and remifentanil 8-10ug·kg^-1·h^-1intravenous infusion.In group D₀,10ml of saline was given intravenously after induction of anesthesia.Patients in group D₁ were given dexmedetomidine 0.5ug/kg（10 minutes pump）before anesthesia induction.After anesthesia induction,the patients with D₂ group were injected with a constant velocity of 0.4ug·kg^-1·h^-1dexmetomidine to stop the drug half an hour before the end of the operation.In group D₃,dexmedetomidine 0.6ug/kg（pump time 10min）was injected before the end of the operation 40 minutes.Keep warm during the operation,maintain Narcotrend between 37-64,maintain end expiratory carbon dioxide partial pressure(P_ETCO₂)between 35-45mmHg,and maintain mean arterial pressure（MAP）as the base value of±20%.At the end of the operation,the drug was stopped and all the patients were sended into postanesthesia care unit（PACU）continued to be observed.And record the patient’s breathing recovery time,open eye time and time of extubation.The changes of hemodynamic indexes at different times of awakening were recorded,namely,the average arterial pressure（MAP）and heart rate（HR）at the beginning of anaesthesia（T0）,30minutes before the end of the operation（T1）,extubation（T2）and 10minutes after extubation（T3）.To record the agitation and calmness of the patients during postoperative resuscitation after neurosurgery.Results:There was no statistically significant difference between the four groups of patients in general information、operation time、intraoperative access、respiratory recovery time、open eye time、tubation time and T0time point MAP and HR.Compared with T1 time point,patients in D₀group and D₁ group were significantly increased at T2 and T3 time points MAP,and HR significantly increased,and the difference was statistically significant（P<0.05）.At the time point of T2 and T3,D₂ group and D₃group MAP and HR are obviously lower than the first 2 groups（P<0.05）.The patients in group D₃ were significantly lower than the first 3groups at the time point of T1 and T2,and the difference was statistically significant（P<0.05）.From the incidence of agitation in the recovery period,the agitation rate in group D₂ and group D₃ was 2.5%and 0respectively,significantly lower than those in group D₀（15%）and group D₁（12.5%）（P<0.05）.From sedation,sedation in group D₂ was significantly better than that in the other three groups.Conclusions:Afterinductioncontinuousinfusionofdexmedetomidine0.4ug·kg^-1·h^-11 until the end of the operation in half an hour,the incidence of emergence agitation of neurosurgery patients was significantly reduced,and reduce the incidence of adverse events,the hemodynamic more smoothly during extubation,calm situation better,to the postoperative recovery of patients in the surgery has certain clinical application value.