The Effects Of Intraoperative Administration Of Dexmedetomidine On Sleep Quality And Fatigue After Operation

[Objective]:To investigate the effects of dexmedetomidine(Dex)on postoperative sleep quality and fatigue degree of patients,and to provide clinical basis for the rational use of anesthesia-related drugs to improve postoperative sleep quality and reduce fatigue degree.[Methode]:Sixty-four patients with vocal cord polyp resection in Otorhinolaryngology were randomly divided into two groups:Group D and Group B.All patients were not given pre-operative medication,after entering the operating room to monitor vital signs,establish venous access,D group(experimental group)was given intravenous infusion of Dexmedetomidine,loading dose 1 Ug/kg,pump finished within 10 minutes,patients in Group B(control group)were given 0.9%sodium chloride solution of the same volume.All patients were anesthetized by tracheal intubation.Anesthesia induction regimen of group D and group B was as follows:Propofol 2mg/kg,sufentanil 0.2-0.4ug/kg,cisatracurium 0.15-0.3mg/kg,tracheal intubation mechanical ventilation after 3-5 minutes;continuous intravenous infusion of 0.2 ? g/(kg · min)remifentanil and 6mg/(kg·h)propofol were given during anesthesia maintenance stage.Maintain the hemodynamic stability of patients,heart rate(HR)and mean pulse pressure(map)fluctuations<20%and bispectral index(BIS)between 45 and 60.When hypotension occurs during the operation,intravenous ephedrine 5mg is injected;hypotension is defined as systolic blood pressure decrease more than 20%of the base value or systolic blood pressure<90mmHg.When bradycardia(heart rate<45 beats/min),atropine 0.5mg was injected intravenously.OUTCOME MEASURES:1.The age,BMI and ASA were recorded.2.The anesthesia time,operation time,blood loss,infusion volume and propofol dosage were recorded.3.BIS values were continuously monitored during the whole course,and BIS values were recorded before(T0),10min(T1),before drug withdrawal(T2)and when leaving the room(T3)for statistical analysis.4.Monitor HR?MAP and SPO2.Record before pump injection(T,0),10 minutes after pump injection(T,1),after tracheal intubation(T,2),at the beginning of operation(T,3),at the end of operation(T,4),and at the time of leaving the room(T,5).5.The incidence of postoperative nausea and vomiting was recorded.6.The length of stay was observed and recorded.7.The patients were asked to fill in the sleep status within one month(TPRO)and one night(T0)before operation.First night(T1)after operation,second night(T2)after operation and third night(T3)after operation are PSQI score was used.8.The fatigue status was recorded one month before operation(TPRe)and one night(T0)before operation.The fatigue severity scale(FSS)was used to score.The fatigue status of patients at the first night(T1),the second night(T2)and the third night(T3)were followed up.The scores were also recorded with FSS fatigue scale.[Rusults]:A total of 64 cases were included in this study.One patient in Group D(Experimental Group)was removed due to intraoperative Bradycardia,and one patient was removed due to intraoperative hypotension induced by ephedrine.In Group B(control group),60 cases were included in the statistical analysis,because the patients were discharged early and could not follow up the questionnaire on the third day after the operation,each group had 30 cases.1.General situation comparisonPatients in two groups with similar age,BMI,ASA grade,anesthesia time,operation time,blood loss,infusion volume and hospitalization time(P>0.05).While the dose of propofol used in group D was significantly lower than that in group B(P<0.05)2.Comparison of BIS values in different periods of operationThe BIS value of group D was significantly lower compared to group B at 10 min(T1)and before withdrawal(T2)after dexmedetomidine pump injection(P<0.05),but no significant difference was observed between the two groups before dexmedetomidine pump injection(T0)and at the time of leaving the room(T3)(P>0.05).3.Comparison of HR,map and SpO2 in each period of operationThere was no significant difference in HR,map and SpO2 between the two groups before pump injection(T,0),10 minutes after pump injection(T,1),after tracheal intubation(T,2),at the beginning of operation(T,3),at the end of operation(T,4),and at the time of leaving the room(T,5)(P>0.05).4.Adverse reactionsCompared to group B,there was significantly decreased incidence of postoperative nausea and vomiting in group D.(P=0.02).5.PSQI scoreComparison between groups:the PSQI score of group B was significantly higher than that of group D at T1 and T2(P<0.05),but there was no significant difference between the two groups at tpro,t0 and T3(P>0.05).Intra group comparison:PSQI scores of the two groups at T1 and T2 were significantly higher than those at tpro(P<0.05),but there was no significant difference between to and T3 and tpro(P>0.05).6.Comparison of PSQI score factorsComparison between groups:the sleep quality and sleep time in group B were significantly improved than those in group D at Tl and T2(P<0.05),but there was no difference at other time points(P>0.05).There was no obvious alterations in sleep time,sleep efficiency,sleep disorders,hypnotics,daytime dysfunction and other factor scores between groups(P>0.05).Intra group comparison:the scores of sleep quality and sleep time at T1 and T2 were significantly higher than those at tpro(P<0.05),but there was no significant difference in the scores of two factors at to and T3 compared with those at tpro(P>0.05).7.FSS scoreComparison between groups:FSS score of group B was higher than that of group D at T1 and T2 with statistic significance(P<0.05).However,no significant changes in PSQI score were observed between two groups at tpro,t0 and T3(P>0.05).Intra group comparison:the FSS scores of the two groups at T1 and T2 were significantly higher than those at tpro(P<0.05),but there was no significant difference between to and T3 and tpro(P>0.05).[Conclusion]:Compared with the control group,the preoperative and intraoperative dexmedetomidine can significantly improve the sleep quality of patients,improve the degree of postoperative fatigue,and then improve the comfort and satisfaction of patients in the perioperative period,accelerate the recovery of patients,and contribute to the development of rehabilitation surgery.Compared with the control group,the preoperative and intraoperative dexmedetomidine can significantly improve the sleep quality of patients and alleviate,the degree of postoperative fatigue,This could bring comfort and satisfaction to patients in the perioperative period and accelerate the recovery of patients.In summary,the strategy of the preoperative and intraoperative dexmedetomidine could contribute to the development of rehabilitation surgery.