Intranasal Dexmedetomidine Combined With Continuous IV Propofol For Painless Gastroscopy Endoscopic Mucosal Resection In Adult Obese Patients

Background and ObjectiveThe implementation of painless gastroscopic treatment in adult obese patients may cause severe respiratory depression besides the large amount usage of anestheticduring the anesthetic inductionperiod.Propofol is one of the most common used drugs for painless gastroscopy as its induction effect is fast,and recovery is quick and complete.If the injectivedosage for obese patient is too large,which can result in a sharp decrease in blood pressure and oxygen saturation,especially combined with narcotics.Dexmedetomidine(Dex)is a highly selective alpha-2 adrenergic receptor agonist,which has a function of sedative,analgesic and anxiolytic properties without obvious respiratory depression.In addition,its adverse reactions are relatively less.Currently,Dex has been widely used as an adjunct drug for anesthesia surgery.But the usage of Dexfor painless gastroscopy for adult obese patients is still lack of clinical information.The purpose of this studywas designed to observe the efficacy and safety of low doses intranasal Dex combined with continuous IV propofol for painless gastroscopy endoscopic mucosal resection in adult obese patients.Materials and MethodsNineties adult obese patients underwent painless endoscopic mucosal resection(EMR),which were ASA physical status ???,BMI>30 kg/M2,were randomly divided into 3 groups(30 patients for each).The groups were propofol alone(group P),0.5 ?g/kg intranasal Dex plus propofol(group DL)and 1.0 ?g/kgintranasal Dex plus propofol(group DL).Before the anesthetic induction of 45 min,group P was given 0.9%intranasal saline of 1 ml,while group DL was given intranasal Dex of 0.5?g/kg,and group DH was given intranasal Dex of 1.0 pg/kg.Blood pressure(BP),heart rate(HR),pulse oxygen saturation(SpO2)and electrocardiogram(ECG)were monitored.After forty-five minutes,before the EMR began,propofol of 1.5-2.5 mg/kg IV were given slowly until the patients fell asleep and the eyelash reflex disappeared,then continuous IV propofol and a dose was added according to the patient's move response.MAP,HR and SpO2 was monitored and recorded atbefore intranasal Dex(TO),30 min after Dex(T1),45 min after intranasal Dex,before propofol induction(T2),the moment propofol was administered(T3),the moment inserting gastroscope(T4),after removing gastroscope(T5),and the moment the patient awaken(T6).The total amount of propofol consumption,EMR operation time,anesthetic induction time,the recovery time,Ramsay Sedation Score,adverse reactions,assess the anesthetic effect,thepatient's satisfaction,and the gastroscope operators'satisfaction were recorded respectively.P<0.05 was considered significant.ResearchResults1.There were no significant difference among the patients age,gender,BMI,and ASA grade,also EMR operation time,and anesthetic induction time among the groups(P>0.05).2.The anesthetic effects of the compound Dex group was generally higher than the groupPalone:the excellent rate of anaesthetic effect in group DH was 96.7%;the excellent rate of anaesthetic effect in group DL was 93.3%;the excellent rate ofanaesthetic effect in group P was 76.7%.The excellent rate of anaesthetic effect in group DL and group DH was better than that of in group P(P<0.05).The total amount of propofol consumption in group DL(452.33±56.49 mg)and group DH(399.67±49.51 mg)were significantly less than that of in group P(532.80±84.87 mg)(P<0.01),while group DH was significantly less than group DL(P<0.01).The recovery time of group DL(5.83±2.09 min)and group DH(5.23±2.22 min)were less than that of in group P(7.10±2.63 min)(p<0.05).Ramsay sedation scores in group P(4.43±0.57)were lower than that of in group DL(2.30±0.47)and DH(2.47±0.51)(P<0.05).MAP in group P was lower at T3,T4 and T5 than in group DL and DH(P<0.05).HR decreased at T3 and T4 in group DL,and at T2 to T4 in group DH compared with group P(P<0.05).The SpO2 of group P at T3 and T4 was lower than that of group DL and group DH(P<0.05).3.All the patients had a certain degree of hypotension and bradycardia among the three groups.The incidence of hypotension in DH group,DL group and P group were:3.3%,20%,36.7%;the incidence of respiratory depression were:6.7%,26.7%,50%;the incidence of restless cough was:3.3%,20%,40%.The incidence of hypotension,respiratory depression,and restless cough was lower in group DHthan in group DLand group P(P<0.05).The patients' satisfaction rate in group DH was 86.7%,the gastroscope operators'satisfaction ratein groupDH was96.6%;The patients' satisfaction rate in group DL was 80%,the gastroscope operators' satisfaction rate in group DL was 80%;The patients'satisfaction rate in group DH was 53.3%,the gastroscope operators' satisfaction rate in group P was 60%.The patients' satisfaction and the gastroscope operators' satisfaction of group DH and group DL were higher than in group P(P<0.05).Research ConclusionsIntranasal Dex(1.0 ?g/kg)combined with continuous IV propofolprovide a safe and effective anesthetic effects in painless gastroscopy endoscopic mucosal resection foradult obese patients.