Effects Of Penehyclidine Hydrochloride On Early Postoperative Sleep Function After General Anesthesia In Elderly Patients

Objective The purpose of this study is to observe the effects of preoperative administration of penehyclidine hydrochloride on early postoperative sleep function in elderly patients undergoing the first total knee arthroplasty(TKA)under general anesthesia.Methods Sixty patients,aged 65 to 80 years,BMI 20 to 30 kg/m~2,ASAⅡorⅢ,scheduled for the first elective total knee arthroplasty(TKA)undergoing total intravenous anesthesia,were randomly divided into two groups(n=30 each)using a random number table:penehyclidine hydrochloride group(group P)and control group(group C).Patients in group P were administrated the intramuscular injection of penehyclidine hydrochlofide 1 mg at 30 mins before operation.Patients in group C were administrated the intramuscular injection of normal saline 1 ml at 30 mins before operation.Postoperative sleep time,efficiency and quality at the first night after operation were evaluated by using the Bispectral Index(BIS)monitor.Pittsburgh Sleep Quality Index(PSQI)was used to evaluate the sleep functions at 1 d before operation and at 1,3 d after operation.The PSQI scale includes 7 items:sleep quality,sleep time,sleep efficiency,sleep disorders,sleep medicines and day dysfunction.Each item is graded by 0 to 3 points(0 points,very good;1 points,good;2points,poor;3 points,very poor),and the accumulated scores are the total scores of PSQI.Postoperative sleep disturbances was defined by the total scores of PSQI≥7.The incidences of early postoperative sleep disturbances in two groups was compared.Blood samples were collected before the induction of general anesthesia,at 1 d after operation for detection of the concentrations of acetylcholine(ACH),acetylcholinesterase(CHE)and melatonin(MT)by Enzyme-linked immunosorbent assay(ELISA).The visual analog scale(VAS)was used to evaluate the intensity of pain at rest and during activity at 1 d before operation and at 1,3 d after operation.The occurrence of adverse reactions related to pentylethylquinone hydrochloride,such as dry mouth and facial flushing,were observed at1,3 d after operation.Results Compared with those of group C,the sleep time in group P was significantly shortened,the sleep efficiency and the sleep quality in group P were significantly decreased at the first night after operation(P<0.05).Compared with those of 1 d before operation,the sleep quality,time to fall asleep,sleep time,sleep efficiency,sleep disorder,daytime dysfunction and PSQI scores at 1,3 d after operation in both groups were significantly increased(P<0.05).Compared with those of 1 d after operation,the sleep quality,time to fall asleep,sleeping time,sleep efficiency,sleep disorder,daytime dysfunction and PSQI scores at3 d after operation in both groups were significantly decreased(P<0.05).Compared with those of group C,the sleep quality,time to fall asleep,sleep time,sleep efficiency,sleep disorders and PSQI scores in group P were significantly increased(P<0.05).Compared with that of group C,the incidence of postoperative sleep disturbances in group P was higher(P<0.05).There was no significant difference for the incidence of postoperatively sleep disturbances at 3 d after operation between the two groups.Compared with those of preanesthesia,the concentrations of ACH,CHE and MT in the two groups were significantly lower at 1 d after operation(P<0.05).Compared with those in group C,the concentrations of ACH in group P were significantly lower at 1 d after operation(P<0.05).Compared with those in group C,the concentrations of CHE and MT in group P had no significant difference at 1 d after operation.The pain scores of VAS at rest and during activity were no statistical differences between the two groups at each time point.No adverse reactions,such as dry mouth and facial flushing,were found at 1,3 d after operation in two groups.Conclusion Preoperative adminietration of penehyclidine hydrochlofide can decrease the sleep quality and sleep efficiency,shorten sleep time,affect the sleep function at the first night after operation in elderly patients undergoing the first total knee arthroplasty(TKA)under general anesthesia.