Effects Of Lidocaine Combined With Dexmedetomidine On The Emergence Of Patients Undergoing Transnasal Transsphenoidal Pituitary Tumor Resection

Objectives:To evaluate the effect of lidocaine combined with dexmedetomidine on emergence cough,on agitation and other complications of patients undergoing transnasal transsphenoidal pituitary tumor resection.Methods:Eighty patients(aged 20?65 years,ASA physical status ? or ?)were randomly assigned into four groups:group DEX(n=19)received dexmedetomidine infusion(0.5ug/kg loading,0.4ug/kg/h infusion),group LIDO(n=18)received lidocaine infusion(1.5mg/kg loading,1.5mg/kg/h infusion),group LIDO+DEX(n=18)received lidocaine(1.5mg/kg loading,1.5mg/kg/h infusion)and dexmedetomidine infusions(0.5ug/kg loading,0.4ug/kg/h infusion),group CON(n=18)received normal saline infusion.The primary outcome was the incidence of emergence cough and cerebrospinal fluid rhinorrhea after operation.The secondary outcome included the extubation time and observation time in the Post-anesthesia care unit(PACU),the incidence of emergence agitation,Mean arterial pressure(MAP)and heart rate(HR)during emergence at the time of into the operating room(TO),3 minutes before extubation(T1),at extubation(T2),5 minutes after extubation(T3),and 10 minutes after extubation(T4).Results:The incidence of emergence cough were significantly lower in group LIDO+DEX compared to other three groups(p<0.05).The incidence of cerebrospinal fluid rhinorrhea after operation in four groups were similar,and there was no statistical difference(p>0.05);The level of MAP,HR in four groups were similar,and there was no statistical difference(p>0.05);The level of MAP,HR in LIDO+DEX group was lower than that in other three groups at T2 time point(p<0.05);The extubation time and observation time in the PACU in LIDO+DEX group were slightly longer than those in CON group,LIDO group and DEX group,but there was no significant difference(p>0.05);The incidence of emergence agitation in LIDO+DEX group was slightly lower compared to other three groups,but there was no significant difference(p>0.05).Conclusions:Lidocaine combined with dexmedetomidine infusion can significantly reduce the incidence of emergence cough,maintain the hemodynamic stability during extubation,and promote the patients undergoing transsphenoidal pituitary adenoma resection more safely through the postoperative recovery period.