The Application Of Dexmedetomidine Combined With Ketamine In Pediatric General Anesthesia

OBJECTIVE:Non-intubation general anesthesia in children is one of the commonly used anesthetic methods in clinical pediatric short general anesthesia,and it has been widely used in children's lower abdomen,extremities,and superficial short operations.Ketamine(Ket)is a commonly used pediatric intravenous general anesthetic and is a N-methyl-D-aspartic acid receptor(NMDA)non-competitive blocker.It has strong analgesic effect,rapid induction,and rapid recovery.Easy to administer and inexpensive,so it has an extremely important position in clinical pediatric surgery.At the same time,ketamine is also prone to adverse reactions such as cardiovascular excitability,postoperative delirium,and psychomotor symptoms,so its clinical application has been limited.Dexmedetomidine(Dex)is a sympathetic sedative with mild to moderate analgesia that reduces postoperative Ket spasm and attenuates sympathomimetic effects caused by Ket.At present,there are few clinical reports on the combination of the two drugs used in pediatric anesthesia.The purpose of this experiment is to study the interaction between Dex and Ket and to initially analyze the synergy and antagonism of the two drugs.Provide basis,but also provide convenient,practical,safe and effective method for anesthesia of children with short general anesthesia.METHODS:A total of 60 children with ASAI grade,2 to 6 years of age,and weights of 8 to 25 kg were selected as subjects and randomly divided into 3 groups.Ketamine group(K group),ketamine compound propofol group(KP group),ketamine compound dexmedetomidine group(KD group),20 cases in each group.Group K: Infusion of Ket 2.0 mg/kg was induced intravenously in anesthetized children and started 1 to 2 minutes later.Intraoperative intravenous injection of Ket 1 mg/kg was performed according to the depth of anesthesia.In the KP group,patients were given a slow intravenous injection of Ket 2.0 mg/kg.In kg,anesthesia was maintained with propofol at a dose of 2-4 mg/kg.h.During the operation,Ket 1 mg/kg was added according to the depth of anesthesia until the end of the surgery.In group KD,patients were given a slow intravenous injection of Ket 2.0 mg/kg.Dex 0.5 ?g/kg(diluted with normal saline 10 ml)The micro-pump was pumped at a constant rate.After the infusion was completed within 10 minutes,it was continuously pumped at 0.25 ?g·kg-1·h-1.Ket 1 was added during the operation according to the depth of anesthesia.Mg/kg.To the end of surgery.Indicators of observation:(1)Observe and record the anesthesia success of the three groups of patients until the end of the operation(operation time),the time from the end of the surgery to the call of their name to blink(wake-up time),and the amount of ketamine used during the operation.(2)Record preoperative(T0),3 min(T1)anesthesia,6 min(T2)anesthesia,T3,5 min(T4),and immediate(T5)anesthesia Heart rate(HR),mean arterial pressure(MAP),pulse oxygen saturation(SpO2),respiratory rate(RR)and other monitoring indicators.(3)After the drug was discontinued,the patient was sent to the anesthesia recovery room and the child was awakened every 5 minutes.The PACU nursing staff used the Eastern Ontario Children's Hospital Pain Scale(see CHEOPS score sheet,see Annex 1)for the postoperative patient.Pain is scored.30 minutes and 60 minutes after surgery,the agitated status of the child was assessed(PAED scale,see Annex 2).(4)Record respiratory depression,intraoperative physical activity,and nausea,vomiting,and other adverse reactions during the anesthesia and resuscitation.Results:There was no significant difference in the general conditions of age,gender,weight,operation duration,dessert rate(HR),mean arterial pressure(MAP),and other symptoms of the three groups(P>0.05).Comparing the three groups of children,KP group compared with K group,HR at T2,T3 time difference was statistically significant,MAP at T2 time point difference;KD group compared with K group,HR at T1-T5 time point Differences existed in MAP except for T1.Compared with T0,HR and MAP increased in K group,HR and MAR slightly decreased in KP group at T2,and HR in KD group was at T1.After a slight increase,it showed a decreasing trend.There was no statistically significant change in MAP at each time point.In the KP group,there were six patients with respiratory depression,three in the K group,and no significant respiratory depression in the KD group.The incidence of postoperative nausea,vomiting,and agitation in the PK group and KD group was significantly lower than that in the K group.P<0.05),but there was no significant difference between KP group and KD group(P>0.05).The ketamine consumption in KD group and KP group was significantly lower than that in K group(P<0.05).KD group was lower than KP group(P<0.05).The sedation scores of the DK and PK groups were significantly higher than those of the K group.The KD group had higher sedation scores than the KP group(P<0.05).The recovery time of the anesthesia recovery room(PACU)was longer in the K group than in the KP group.The KD group was significantly prolonged(P<0.05).There was no significant difference between the KP group and the KD group(P<0.05).Conclusion:The combination of dexmedetomidine and ketamine combined anaesthesia is safe and feasible in pediatric short general anesthesia.Compared with ketamine alone or ketamine combined with propofol,the hemodynamics can be maintained more effectively during the operation.It can not only reduce the use of ketamine,but also reduce the occurrence of adverse reactions such as respiratory depression,nausea and vomiting,and can effectively reduce the occurrence of restlessness in children's recovery period.