Acomparative Study Of Three Administration Routes Of Dexmedetomidine In The Treatment Of Preoperative Anxiety Insomnia

Objective:The aim of this study was to explore the best way to treat preoperative anxiety insomnia in surgical patients with dexmedetomidine given viatheoral and nasal mucosa.Methods:A total of 138 patients undergoing day surgery between January 2022 and January 2023 were selected for the study and randomly divided into three groups according to the inclusion criteria:intranasal group（INS）,dexmedetomidine 2μg/kg nasal drip;nasal atomize group（ATO）,dexmedetomidine 2μg/kg nasal spray;the buccal mucosa group（BUC）,dexmedetomidine was sprayed on the buccal mucosa at 2μg/kg.Among them:7 patients withdrew from the experiment due to fear during the experiment,8 were excluded due to non-compliance with medical advice,and 1withdrew from the experiment due to leaving the hospital midway.122 patients were finally included in this study,including 41 in the INS group,41 in the ATO group,and 40 in the BUC group.The medication was started one hour before going to sleep the night before surgery.The time of wakefulness（awake period after eye closure+N₁period）and the total duration of sleep（N₂+N₃+N₄+REM period）were recorded using a mobile polysomnography monitor,and the patients’vital signs were also monitored.When the blood pressure（BP）exceeded 20%of the pre-experimental baseline and the HR was below 50 beats per minute,drug intervention was used.When the Sp O2 was below90%,the patient’s head was tilted to the side or the patient was gently supported The airway was opened by the lower jaw and medication was administered by an anesthesiologist who was unaware of the group’s condition.The primary observations were time to wakefulness,total duration of sleep,post-treatment insomnia severity index scale（ISI）score and patient satisfaction（based on patient subjective judgment:excellent or good）;secondary observations were Sp O2,MAP,HR before（T₀）,15 min after（T₁）,30 min after（T₂）and 60 min after（T₃）drug administration,and drug adverse reactions（hypoxia,sinus bradycardia,hypotension,dizziness and headache）.Results:1.Comparison of the general conditions of the three groups of patients:age,sex,weight,and pre-experimental ISI,theresults showed that thedifferences werenot statistically significant（P>0.05）.2.Comparison of Sp O₂:1)Comparison of different time points within each group:compared with the T₀moment,Sp O₂in the INS group,ATO group,and BUC group was lowerat the T₃moment than at the T₀moment（P<0.05）,and the difference was statistically significant;T₁and T₂were not statistically significant compared with the T₀moment（P>0.05）,indicating that Sp O₂decreased at 60min after drug administration,but they were all higher than 90%,without.2)comparison between groups at the same time point:the differences were not statistically significant（P>0.05）when comparingthe Sp O₂of each group at themoments of T₀,T₁,T₂and T₃.3.Comparison of MAP:1)Comparison between different time points within each group:compared with the T₀moment,MAPin the INS group,ATO group,and BUC group was significantly higher at the T₃moment than at the T₀moment（P<0.001）,showing a statistically significant difference（P<0.05）,and the difference between T₁and T₂compared with the T₀moment was not statistically significant（P>0.05）,indicating that MAP at 60 min after drug administration all decreased,but all of them were above 70 mm Hg,and no intervention was needed;2)comparison between groups at the same time point:the differences were not statistically significant（P>0.05）when comparing the MAPof eachgroup at themoments of T₀,T₁,T₂and T₃.4.Comparison of HR:1)Comparison of different time points within each group:compared with the moment of T₀,HR in the INS group,ATO group,and BUC group was significantly lower at the moment of T₂and T₃（P<0.001）,and the difference was statistically significant（P<0.05）,compared with the moment of T₁,HR in all three groups was significantly lower at the moment of T₃（P<0.001）,and the difference was statistically significant（P<0.05）,indicating that HR decreased at 30min and 60 min after drug administration,but all of them were above 50 beats/min,and no intervention was needed;the differences were not statistically significant when comparing T₁with T₀and T₁with T₂（P>0.05）;2)Comparison between groups at the same time point:the differences were notstatistically significant whencomparing HRat T₀,T₁,T₂and T₃moments ineach group（P>0.05）.5.Comparison of wakefulness time:all patients successfully fell asleep,the wakefulness time of patients in the INS group was（23.07±2.51）min,that of patients in the ATO group was（20.26±2.38）min,and that of patients inthe BUC group was（24.15±4.36）min.The comparison of the wakefulness time of patients in the three groups was the shortest in the ATO group and the longest in the BUC group,and the difference between the three groups was statistically significant（P<0.001）.The results of multiple comparisons within each group of the three groups showed that the difference was statistically significant（P<0.05）between the INS and ATO groups:P<0.001;P=0.133 between the INS and BUC groups,with no statistically significant difference（P>0.05）;P_c<0.001 between the ATOand BUC groups,with a statistically significant difference（P<0.05）.6.Comparison of total sleep duration:the total sleep duration of patients in the INS group was（405.70±33.48）min,the total sleep duration of patients in the ATO group was（418.73±30.93）min,and the total sleep duration of patients in the BUC group was（383.60±25.98）min.The difference between the three groups was statistically significant（P<0.001）.The results of the multiple comparisons of the total duration of sleep in each of the three groups showed that the difference between the INS and ATO groups was statistically insignificant（P>0.05）:P=0.054;P=0.001 in the INS and BUC groups,with a statistically significant difference（P<0.05）;P<0.001 in the ATO and BUCgroups,with a statistically significant difference（P<0.05）.7.Comparison of ISI after medication:the ISI after experiment was（3.146±1.406）for patients in the INS group,（2.341±1.015）for patients in the ATO group,and（3.250±1.276）for patients in the BUC group,the ISI after experiment was the smallest in the ATO group and the largest in the BUC group in the comparison of the three groups.The difference was statistically significant（P=0.002<0.05）.The results of multiple comparisons of the post-experimental insomnia severity index scale（ISI）within each of the three groups of patients showed that the difference between the INS and ATO groups was statistically significant（P<0.05）:P=0.012;P=0.980 in the INS and BUC groups,with no statistically significant difference（P>0.05）;P=0.002 in the ATO and BUC groups,with a statistically significant difference（P<0.05）.was statistically significant（P<0.05）.8.Comparison of ISI before and after medication:The comparison of the index scale of insomnia severity（ISI）between the three groups of patients before and after the experiment showed that all the differences were statistically significant（P<0.001）,suggesting that ISI decreased significantly afterthe use of dexmedetomidine inall three groups.9.Comparison of sleep satisfaction after medication:P>0.05 for the comparison of patients in the INS and BUC groups,with no statistically significant difference,but P<0.05 for the comparison between the ATO and INS groups and between the ATO and BUC groups,with a statistically significant difference;the number of patients with excellent satisfaction in the ATO group was the highest（36）,and thesatisfaction rate was the highestreaching 87.8%.10.Adverse reactions:the adverse reactions（hypotension,hypoxia,sinus bradycardia,dizziness and headache）in the three groups of patients after the experiment were all compared between groups at P>0.05,andthe differences were not statistically significant.Conclusion:1.In this experiment,dexmedetomidine nasal drip,nasal spray and buccal mucosal spray administration caused a decrease in MAP,HR and Sp O₂,but they were all within the safe range,indicating that they were safe andeffective in the treatment of preoperativeanxiety insomnia.2.Compared with nasal drip and buccal mucosal spray,dexmedetomidine given intranasally for the treatment of preoperative anxiety insomnia resulted in faster sleep,longer sleep duration and no significant increase in the incidence of drug-related adverse effects,making it the best route of administration among the three.