The Effect Of Combination Of Dyclonine And Dexamethasone During Extubation In Patients Undergoing Hysterectomy With Laparoscopy

Objective: Daconine and dexamethasone were mixed and applied to the anterior part of trachea catheter and then endotracheal intubation was performed to observe the effects of Daconine and dexamethasone on hemodynamics and cough reaction during anesthesia recovery and extubation in patients undergoing laparoscopic hysterectomy.The complications of tracheal intubation,such as sore pharynx,hoarseness,expectoration and so on,were observed after operation.To explore the effect of local combination of Daconine and Dexamethasone on the incidence and intensity of adverse reactions during extubation,especially the incidence and intensity of cough,in order to improve the safety and comfort of awakening quality in patients undergoing hysterectomy with general anaesthesia.Methods: 60 patients with elective laparoscopic hysterectomy,ASA grade I to grade II,age 35-55,BMI 17-27 were randomly divided into three groups: blank group(coated with paraffin oil,group B),and Dyclonine group(Dacroin alone,Group D)and the combination group(in combination with dyclonine and dexamethasone,group L),20 patients in each group.Before the trachea cannula of the blank group,the tracheal tube should be coated with paraffin oil,5 ml of the Dancin glue slurry was applied to the first 1/2 of the tracheal catheter before the tracheal intubation in the Dyclonine group,and 2 g of dexamethasone and 5 ml of Dyclonine were uniformly applied to the first 1/2 of the tracheal catheter before the tracheal intubation of the patients in the Dyclonine group.After the treatment was completed,all the patients in the three groups were treated with routine rapid induction intubation,intravenous anesthesia and inhalation combined anesthesia were used during the operation,and the BIS value was maintained between 45 and 55.At the end of the operation,intravenous injection of torisetron 5mg and butofino 1mg was given to prevent the postoperative nausea,releasing the pain and vomiting,and the PCIA was relieved after the operation.Mean arterial pressure(MAP)and heart rate(HR)were recorded before operation(T0),after entry(T1),immediately after intubation(T2),after intubation 5min(T3),end of operation(T4),extubation(T5)and return to ward(T6)in the three groups;Observation and record of cough score during extubation in three groups;To record the occurrence of cough during endotracheal catheter balloon extraction;The incidence and rating of hoarseness,pharyngalgia,and expectoration at 24 h after the operation were recorded at the postoperative visit.Results:1.General data: there was no significant difference in age,body mass index(BMI)and tube time among the three groups(P> 0.05).2.Mean arterial pressure(MAP)and heart rate(HR)in three groups of patients: There was no significant difference in mean arterial pressure(MAP)between Dyclonine group(D group)and combined group(L group)before operation(T0)and mean arterial pressure(MAP)during extubation(T5);The mean arterial pressure(MAP)of the pre-operation(T0)of the blank group(group B)was significantly lower than the mean arterial pressure(MAP)at the time of extubation(T5)(P<0.05).3.Cough score during extubation in three groups: The score of cough during extubation in combination group(L group)was significantly lower than that in blank group(B group)and dyclonine group(D group),the difference was statistically significant(P< 0.05);Besides,The score of cough during extubation in Dyclonine group(D group)was significantly lower than that in blank group(B group),the difference was statistically significant(P< 0.05).4.The incidence of cough in three groups of patients while endotracheal catheter balloon extraction: In group B,group D and group L,the patients with choking or aggravating cough were positive.The positive rates were 85%,80%,and 50%.Compared with the combined treatment group(group L),the incidence of cough in both group B and group D was significantly higher than that in group D(?2=0.018 ??2=0.047,P<0.05);There was no significant difference in the incidence of cough between the blank group(group B)and the Dyclonine group(group D)during endotracheal balloon aspiration(?2=0.677,P>0.05).5.Hoarseness at 24 h after operation in three groups: The incidence of hoarseness in group B,group D and group L was 30%,5% and 5% respectively.The condition of hoarseness in the combination group(L group)was slightly lower than that in the blank group(B group),and the difference was statistically significant(P< 0.05);The hoarseness of the patients in the Dyclonine group(group D)was mild in the blank group(group B),and the difference was statistically significant(P<0.05);There was no significant difference in the hoarseness between the combination group(L group)and the dyclonine group(D group)(P> 0.05).6.Pharyngeal pain in three groups at 24 h after operation: The incidence of throat pain in blank group(group B),dyclonine group(group D)and combination group(group L)was 55%,20% and 10% respectively at 24 hours after operation.In combination group(group L),there was a slight difference in the pharyngeal pain of the patients in the blank group(group B),and the difference was statistically significant(P<0.05).The pharyngeal pain in Dyclonine group(D group)was slightly lower than that in blank group(B group),the difference was statistically significant(P <0.05);There was no difference in pharyngeal pain between combined group(L group)and dyclonine group(D group)(P> 0.05).7.Expectoration 24 hours after operation in three groups: The incidence of expectoration 24 hours after operation in blank group(group B),dyclonine group(group D)and combination group(group L)was 40%,15% and 5%,respectively.The expectoration in the combination group(L group)was slightly lower than that in the blank group(B group),and the difference was statistically significant(P< 0.05);There was no difference in expectoration between group D and group B(P> 0.05);There was no difference in sputum cough between combined group(L group)and dyclonine group(D group)(P> 0.05).Conclusion:Daconine combined with Dexamethasone can effectively stabilize hemodynamics during extubation of trachea catheter during general anesthesia in patients undergoing laparoscopic hysterectomy,reduce the incidence of cough reaction,and improve the conditions of pharynx pain,hoarseness and expectoration 24 hours after operation.