| Objective:The purpose of this study was to explore the clinical sedative effect and safety before anesthesia induction in ophthalmic children with general anesthesia by using the same dose of dexmedetomidine nasally or sublingually,so as to provide theoretical basis for the selection of rational drug delivery approaches in clinical children.Methods:A total of 141 children with general anesthesia induced by dexmedetomidine for sedation before anesthesia were enrolled in this study in our hospital from January 2017 to May 2018,aged 2.1-4.2 years,weighted 12?21.1 kg,ASA grade ???.The above subjects excluded children with allergies to dexmedetomidine,with symptoms of respiratory infection within 2 weeks,with congenital heart disease and mental disorders.The above children were divided into three groups by random data table method:the control group(47 cases),the nasal drops group(47 cases)and the sublingual group(47 cases).The children in the control group received saline injection 1mL sublingually,and the children in the administration group were given 2.5 ?g/kg dexmedetomidine nasally or sublingually 30 minutes before operation.In the nasal dropping group,dexmedetomidine3was diluted to 1mL with saline,and then administered in the bilateral nostrils at the same volume;in the sublingual group,dexmedetomidine was diluted to 1 mL with saline.All the children entered the preoperative preparation room accompanied by their parents,and the heart rate(HR),blood pressure(BP)and blood oxygen saturation(SpO2)of children were closely monitored and recorded.Drug was administered by a specialized anesthesiologist and the acceptance of the child was evaluated(good:obeying an anesthesiologist,no resistance;general:non-violent resistance behavior,persuasion can be persuaded;poor:obvious and the intense resistance behavior,crying is serious,need to use external force to induce pre-anesthesia administration).Time to fall asleep,postoperative recovery time were compared in the three groups of children with different administration routes.The sedation status of the children was assessed using the Ramsay Sedation Rating Scale.30 minutes later,a professional nurse performed venous indwelling needle puncture.After successful puncture,the child was sent into the operation room.Ramsay sedation scale was used to assess venipuncture,separation from parents and face mask acceptance.The anesthesia was maintained by total intravenous anesthesia after laryngeal mask placement,and child was sent to the anesthesia recovery room(PACU)with laryngeal mask after operation.After the child meeted the extubation condition,the laryngeal mask was pulled out.Staying in the PACU for at least one hour,the child could leave the PACU and return to the ward after reaching more than 4 points by Steward score.After the operation,doctor adviced the family members to pay special attention to details and made recommendations for nursing operations The children were interviewed 4 hours after the operation and the related discomforts such as nausea,vomiting,pain,drowsiness were closely inquired and recorded.All data were analyzed and processed by SPSS 20.0 statistical software,P<0.05 showed that the difference was statistically significant.Results:1.There were no significant differences in the age,gender,height,weight and ASA classification of the above three groups(P>0.05).2.Ramsay Sedation Rating Scale Results:The preoperative sedative effect,venipuncture,separation from the parents and face mask acceptance of the above-mentioned children by intranasal and sublingual administration were significantly better than that of the control group,and the difference was statistically significant(P<0.05).Compared with the sublingual group,the sedative effect of the nasal dropping group was significantly improved(P<0.05),but there was no significant difference in venipuncture effect,separation from parents and face mask acceptance(P>0.05).3.Acceptance of different routes of administration:There was a significant difference in the acceptance of different routes of administration in the above-mentioned children.The acceptance of the nasal route was poor,and the acceptance of the sublingual was relatively good.The acceptance of different routes of administration was statistically significant(P<0.05).4.Hemodynamic changes before and after treatment:The hemodynamic indexes including heart rate(HR),blood pressure(BP)and blood oxygen saturation(SpO2)fluctuated in a certain range before and after treatment,but the difference was not statistically significant(P>0.05).5.The time to fall asleep in nasal dropping group was(11.53 ± 0.33)minutes,and that in sublingual taking group was(19.71 ±0.84)minutes,which was significantly shorter than that in control group(31.71 ± 0.61)minutes.While the time of recovery was(45.62± 1.62)minutes in nasal dropping group,and(58.62 ± 1.91)minutes in sublingual group,which was significantly longer than that in control group(35.62 ± 1.33).The difference was statistically significant(P<0.05).Compared with the sublingual group,the falling asleep time and recovery time were significantly shorter in the nasal dropping group(P<0.05).Compared with the control group,the incidence of postoperative pain,nausea and vomiting in the nasal group and sublingual group was significantly lower,but the incidence of drowsiness increased significantly(P<0.05).Compared with the sublingual group,the incidence of pain,nausea and vomiting in the nasal dropping group was lower(P<0.05),but there was no significant change in drowsiness(P>0.05).Conclusion:1.The preoperative sedative effect of the same dose of dexmedetomidine administered by intranasal route is significantly better than that of sublingual administration,but there is no significant difference in Ramsay Sedation Score between the groups in terms of venipuncture effect,separation status from parents and face mask acceptance.2.There is a significant difference in the acceptance of different routes of administration in the above-mentioned children:the acceptance of the nasal route is poor,and the acceptance of the sublingual is relatively good.3.The same dose of dexmedetomidine applied intranasally can effectively shorten the time of sleep and the time of postoperative resuscitation in children,and the sedative effect is significantly better than that of sublingual administration.4.The incidence of adverse reactions such as postoperative pain,nausea and vomiting in the nasal dropping group with the same dose of dexmedetomidine is significantly lower than that in the sublingual group,but there is no siginificant difference in drowsiness. |
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