| Objective This study aims at the risk of injury or even amputation due to unclear surgical field during the operation of exploring spinal nerve and spinal cord in clinical spinal surgery.Therefore,the exposure of surgical field and the reduction of bleeding to maintain the clarity of surgical field have become the crucial important measures.To this end,this project aims to compare dexmedetomidine and propofol in spinal surgery controlled hypotension research,try to explore the efficacy and safety of dexmedetomidine assisted hypotension measures in this kind of surgery,and provide reference for clinical selection of ideal controlled hypotension drugs.Methods Forty patients scheduled for elective spinal surgery with controlled hypotension from January to October,2019 in our hospital,including 19 males and 21 females,aged 18?65 years,body mass index 18.5?25 kg/m2,American Society of Anesthesiologists physical status ???,were selected and randomly divided into two groups:dextromethoridine group(group A)and propofol group(group B),with 20 patients in each group.The implementation of intraoperative controlled hypotension is from the beginning of skin incision to the end of vertebral cage placement.The technique of intraoperative controlled hypotension is to maintain the mean arterial pressure(MAP)at 75%?80%of the preoperative baseline map value,but not less than 55 mmHg.Anesthesia induction:before anesthesia induction,dexmedetomidine was infused intravenously in group A with a dosage of 0.8?g/kg for 15 min.The anesthesia induction was the same in the two groups.Implementation of controlled hypotension:the patients in group A were given dexmedetomidine(infusion rate:0.3 ?g·kg-1·h-1)intravenous infusion combined with sevoflurane;the patients in group B were given propofol constant speed(infusion rate was 3 mg·kg-1·h-1)intravenous infusion combined with sevoflurane.Bispectral index(BIS)was observed during the operation.If the bispectral index(BIS)value was lower than 40 and MAP was still higher than the target blood pressure,nitroglycerin was given to rescue.The surgical field quality was scored by the spine surgeon according to the Fromme score when the target blood pressure reached 30 minutes.The infusion of dexmedetomidine and propofol was stopped in both groups after the insertion of the fusion cage.HR And MAP were recorded at anesthesia before after entering the room(T0),immediately after intubation(Ti),at the beginning of controlled hypotension(T2),at skin incision(T3),at 30 min after surgery(T4),at the end of surgey(T5)and 5 min after extubation(T6).The time from T2 to target blood pressure,sevoflurane inhalation concentration at T2,T3 time points and BIS value at T2,T3 and T4 time points were recorded.The consumption volume of sevoflurane at 30 minutes after reaching the target blood pressure was recorded.Sedation agitation scale(SAS)was performed at T6 time point.The operation time,intraoperative blood loss,urine output,the use of nitroglycerin and abnormal Electrocardiogram(ECG)were recorded.The time from the end of operation to extubation,adverse reactions during anesthesia recovery period and the visual analogue scale(VAS)were also recorded before transferring out of post anesthesia recovery room(PACU).The measurement data were analyzed by one-way ANOVA,t-test and rank sum test.The counting data were statistically analyzed by Chi square test Test.P<0.05 was considered statistically significant.Results 1.There were no significant differences in gender composition,age and BMI between the two groups(P>0.05).2.There was no significant difference in MAP at T0 time point between the two groups(P>0.05),and there was no significant difference in mean arterial pressure at each time point between the two groups during controlled hypotension(P>0.05).Compared with T0 time point,there were significant differences in MAP between the two groups at T3 time point and T4 time point(P<0.05).Compared with group B,HR was significantly decreased in group A(P<0.05).3.There were no significant differences in operation time,operation field quality score,intraoperative blood loss and urine volume between the two groups(P>0.05).4.There was no significant difference in sevoflurane consumption volume between the two groups at 30 min after reaching the target blood pressure(P>0.05).The time from T2 time point to target blood pressure in group B was shorter than that in group A(P<0.05),and the BIS value in group A was significantly higher than that in group B(P<0.05).The time from the end of operation to conscious extubation of tracheal tube in group B was shorter than that in group A(P<0.05).5.The incidence of adverse reactions during anesthesia recovery period in group B was significantly higher than that in group A,and the SAS score at T6 time point,and the vas score at the time of transferring out of anesthesia recovery room in group A were significantly lower than those in group B(P<0.05).Conclusion Dexmedetomidine used for controlled hypotension in spinal surgery can make the heart rate and mean arterial pressure of patients decrease steadily,achieve satisfactory effect of controlled hypotension,improve the quality of surgical field,maintain appropriate depth of anesthesia,reduce or avoid the use of antihypertensive drugs,improve the quality of recovery from anesthesia and improve patient satisfaction.It is one of the safe and feasible measures of controlled hypotension in spinal surgery. |
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