Observation Of The Effect Of Opioid-free Generalanesthesia In Flexible Ureteroscppy With Holmium Laser Lithotripsy

Object Flexible ureteroscopy with holmium laser lithotripsy is the main measures for the treatment of urinary calculi.It has the characteristics of minimally invasive,effective,and safe.The success of its treatment cannot be separated from the choice of anesthesia.In recent years,opioid-related deaths have been on the rise due to the prevalence and abuse of opioids.The opioid-free anesthesia was developed in response to the proposed interventions for the opioid crisis.Opioid-free anesthesia is a multimodal anesthesia combined with sedatives,local anesthetics,non-steroidal anti-inflammatory drugs,alpha-2 receptor agonists,etc.The purpose is to minimize the use of opioids or no opioids thereby avoiding many side effects caused by opioids.This study started with general anesthesia and explored the anesthesia effect of opioid-free anesthesia in flexible ureteroscopy with holmium laser lithotripsy.Methods A total of 83 patients were selected from the second affiliated hospital of Chongqing Medical University from December 2018to November 2019 under general anaesthesia with soft ureteral holmium laser lithotripsy.The subjects were randomly divided into an experimental group?41 cases?and a control group?42 cases?.Both groups were given 1?g/kg dexmedetomidine pumping 10 minutes before anesthesia induction,the control group was given 0.5-5?g/kg sufentanil during anesthesia induction,and the corresponding saline was given to OFA group.After induction of anesthesia,a laryngeal mask was placed through the mouth to establish an artificial airway.During anesthesia maintenance,the control group used remifentanil combined with propofol,and the sevoflurane combined with propofol was used in the OFA group.The mean arterial pressure?MAP?,heart rate?HR?,bispectral index?BIS?at six time points were compared between the two groups at 10 minutes before anesthesia induction?T₀?,at the time of loss of consciousness?T₁?,immediately after the laryngeal mask?T₂?,at the beginning of the surgery?T₃?,at the end of the surgery?T₄?,and at the time of extraction of laryngeal mask?T₅?.The dosage of propofol and the use of intraoperative vasoactive drugs were recorded.The anesthesia recovery time and postoperative complications were recorded,and the patients were given VAS,BCS,and Ramsay sedation score when they left the operating room.Record QoR-15 scale score and the occurrence of opioid-related adverse events on the first postoperative day.Results1 There was no statistical difference between the two groups in general informaion?P>0.05?.2 Comparison of MAP,HR,BIS and the use of vasoactive drugs at six time points:T₂ time point,the values of MAP and BIS in OFA group were higher than those in the control group?P<0.05?,and there was no significant difference at other time points?P>0.05?;At the T₄ time point,the values of HR in OFA group were higher than that of the control group?P<0.05?,and there was no significant difference at other time points?P>0.05?.3 The dosage of propofol and the use of vasoactive drugs:there was no statistical difference in the dosage of propofol and the use of vasoactive drugs between the two groups?P>0.05?.However,in terms of the total amount of propofol used in the two groups,the total amount of propofol used in OFA group was much lower than that in the control group?P<0.05?.4 There was no significant difference between the two groups in VAS score,BCS score,Ramsay sedation score and postoperative complications?P>0.05?.5 There was no significant difference in QoR-15 scale scores and opioid-related adverse events between the two groups on the first postoperative day?P>0.05?.Conclusion1 OFA in general anesthesia can effectively suppress the stress response when placing the laryngeal mask,and keep the induction of anesthesia stable.2 OFA in general anesthesia achieves good quality of recovery and patient comfort,confirming its feasibility and safety.3 OFA in general anesthesia has the same early postoperative recovery effect,which can replace traditional opioid anesthesia and achieve satisfactory anesthesia effect and quality.