Effects Of Different Doses Of Dexmedetomidine Nasal Drops On Hemodynamics And Postoperative Sore Throat In Children Undergoing Tonsillectomy And Adenoidectomy

Objective:The purpose of this study is to observe the effects of different doses of Dexmedetomidine（DEX）nasal drops on hemodynamics and postoperative sore throat in children undergoing tonsillectomy and adenoidectomy,so as to provide clinical reference for the pain management of children after tonsillectomy and adenoidectomy.Methods:100 American Society of Anesthesiologists（ASA）physical statusⅠchildren who were aged between 6 to 10 years,weighted 18-36 kg and scheduled for tonsillectomy and adenoidectomy were recruited for the study from December 2018to December 2019 in Huaian First Hospital Affiliated to Nanjing Medical University.The enrolled children were divided into 4 groups with 25 cases in each group by simple random sampling:D1-3 group with different dose of DEX and control group（Group C）.Vital signs monitoring including mean arterial pressure（MAP）,respiratory rate（RR）,heart rate（HR）,electrocardiogram（ECG）,pulse（P）,pulse oxygen saturation（Sp O₂）,bispectral index（BIS）,body temperature monitoring were established after entering operating room.Anesthesia was induced with intravenous fentanil 4μg/kg,propofol 2 mg/kg and rocuronium 0.6 mg/kg.Mechanical ventilation was maintained with a tidal volume of 6-8 ml/kg,and the ventilatory frequency was set at 16-18 times/min.An appropriate depth of anesthesia（BIS 40 to60）was maintained by adjusting the infusion rate of propofol（6-8 mg/kg/h）and remifentanil（0.3-0.4μg/kg/min）.Remifentanil and propofol were discontinued 5minutes before the end of the operation.The children entered PACU and waited for natural resuscitation after the operation.The tube was extubated in a lateral position after the child was fully awake.DEX was instilled through the bilateral nasal cavity after the extubation for 2 minutes.In group D,1ml of DEX solution[0.5μg/kg（group D1）,1.0μg/kg（group D2）,1.5μg/kg（group D3）]was instilled into the nasal cavity on both sides,and 1ml of normal saline solution（Group C group）were drip into the nasal cavity,respectively.Sedation scores,HR,MAP,Sp O₂and postoperative agitation,nausea and vomiting were recorded at 0 min（T₁）,15 min（T₂）,30 min（T₃）,60 min（T₄）after nasal drip.Sedation score,pharyngeal pain at rest and swallowing were recorded at 6 h（T₆）,24 h（T₇）,48 h（T₈）and 72 h（T₉）after surgery.Results:Compared with group C,MAP and Sp O₂in children in D1,D2 and D3showed no significant difference（P>0.05）,and HR in children in D3 group was significantly lower than that in D1,D2 and C group（P<0.05）.The sedation score of D2 group was significantly better than that of C group and D1 group（P<0.05）,and the sedation score of D3 group was significantly better than that of D2 group（P<0.05）.The restlessness score and incidence of agitation after extubation in D2 and D3 groups were significantly lower than those in C group and D1 group（P<0.05）.The resting pharyngeal soreness of the children in the three groups showed a trend of rising and then falling with the change of treatment time,but there was no statistical difference compared with group C（P>0.05）.At the time point（T₇and T₈）,the swallowing pharyngeal pain in D2 group and D3 group was better than that in D1group and C group（P<0.05）,but there was no statistical significance in the swallowing pharyngeal pain in D2 group compared with D3 group（P>0.05）.Compared with the C group,the incidence of total adverse reactions was lower in the D2 and D3 groups（P<0.05）.Conclusion:Although 1.5μg/kg DEX could improve pharyngeal pain in children undergoing tonsillectomy and adenoidectomy,the heart rate in children was lower and the degree of sedation was deeper than 1.0μg/kg DEX.Therefore,1.0μg/kg DEX can improve pharyngeal pain,and has good hemodynamic safety.