Clinical Application Of Pre-injection Dexmedetomidine With BIS Monitoring In Painless Bronchoscopy

BACKGROUND:With the development of endoscopic technology and the deepening of anesthesia research,painless fiberoptic bronchoscopy has been widely used in the diagnosis and treatment of respiratory and pulmonary diseases,and has become an important part of comfortable medical treatment.At present,there are many anesthesia methods for painless fiberoptic bronchoscopy,and propofol intravenous general anesthesia or compound opioid drugs are commonly used in clinic.When propofol is used in total intravenous anesthesia,it could be effective to inhibit the adverse stimulation of bronchoscopy on the body,while compound opioid analgesics could not only reduce the dosage of propofol,but also meet the patient’s demand for sedation and painless.However,in clinical observation,it is found that under the combined anesthesia of propofol,patients are prone to over sedation,hypoxemia and hemodynamic instability during the operation,so the related anesthesia methods are worth further study and discussion.Dexmedetomidine is a new type of auxiliary sedative drug,which has certain advantages in fiberoptic bronchoscopy(FOB).It could provide patients with moderate sedation,stable hemodynamics,satisfactory comfort.Pre-injection dexmedetomidine combined with propofol and sufentanil for sedation and analgesia during the operation is rarely studied in FOB,so the clinical observation of this anesthesia method is carried out in this study,which could provide a certain reference and basis for the selection of bronchoscopy anesthesia method.OBJECTIVE:To investigate the application advantages of pre-injection dexmedetomidine combined with propofol and sufentanil under BIS monitoring in painless fiberoptic bronchoscopy.METHODS:From April 2019 to July 2019,a total of 70 patients were enrolled for flexible bronchoscopy.The patients were divided into two groups: the control group(n=35,sufentanil 0.1μg/kg was intravenously injected 5 minutes before operation)and the observation group(n=35,dexmedetomidine 0.75μg/kg was injected intravenously 15 minutes before operation,sufentanil 0.1μg/kg was intravenously injected 5minutes before operation.).The anesthesia was induced and maintained with 0.5-2mg/kg propofol under themonitoring of BIS.Observe and record HR,MAP,Sp O2,BIS and MOAA/S sedation scores at the time of entering the room(T0),starting to pump dexmedetomidine(T1),intravenous sufentanil(T2),starting of operation(T3),5 minutes after the start of operation(T4),10 minutes after the start of operation(T5),the end of operation(T6),awakening of the patient(T7),and before the patient leaves the operation room(T8).After the operation,the dosage of drugs,anesthesia time,the occurrence of adverse reactions and the satisfaction score of the tracheoscopist were statistically analyzed.RESULTS:(1)In terms of hemodynamics,the observation group showed relatively stable during the operation.The heart rate of the observation group was lower than that of the control group(P<0.05)within 10 minutes after the operation;the MAP of the control group was higher than that of the observation group at T4 time point,but lower at T5 time point(P<0.05);the Sp O2 of the observation group was higher than that of the control group(P<0.05).(2)In terms of sedation monitoring,At the time point of T3-T7,the BIS value of the observation group was lower than that of the control group(P<0.05).The difference of MOAA/ S between the two groups was not statistically significant.(3)In terms of operation time,the anesthesia time,wake-up time and out of the room time of the observation group were longer,and the difference was statistically significant(P < 0.05).(4)The use of propofol in the observation group was lower than that in the control group(157.71 ± 55.38 vs 213.14 ± 58.44,P < 0.05).(5)In terms of adverse reactions after operation,the observation group was better.The incidence of choking cough in 6 cases(17.14%)and hypoxemia in 4cases(11.43%)in the observation group were lower than that in the control group(P < 0.05).In the evaluation of patients’ and doctors’ satisfaction,the score of the observation group was better than that of the control group(P < 0.05).CONCLUSION:Dexmedetomidine combined with propofol and sufentanil could be safely used in painless bronchoscopy,which could provide stable hemodynamics while maintaining similar sedation depth,reduce the incidence of adverse reactions,and improve the satisfaction of patients and surgeons.