| Objective.In this study,we investigated the effectiveness and safety of different doses of alfentanil compounded with dexmedetomidine in anesthetic sedation for painless bronchoscopy to determine the feasibility of the combination for bronchoscopy and to explore the appropriate doseof alfentanil for clinicalapplication Methods.Ninety patients who underwent elective bronchoscopy between July 2022 and January 2023 in our hospital were selected and signed an informed consent form,and all patients were randomly divided into three groups using the random number method: group A(dexmedetomidine 0.5 μg/kg + alfentanil 5 μg/kg),group B(dexmedetomidine 0.5 μg/kg +alfentanil 10 μg/kg),and control group(dexmedetomidine 0.5μg/kg),30 patients in each group.Patients were routinely fasted for 8 h and abstained from drinking for 2 h.After admission,intravenous access was opened and penehyclidine 0.5 mg was given intravenously to reduce airway secretion,while SBP,HR,and Sp O2 were monitored.anesthesia was started after completion.anesthesia protocol: patients were placed in semi-recumbent position,and all groups were given oxygen-driven 2% lidocaine nebulized inhalation for 10 min,and a loading dose of Dexmedetomidine 0.5μg/kg(pumping time 10min),and then adjusted to0.7ug/kg/h for maintenance;before preparation for operation,group A was slowly sedated(time > 30s)with alfentanil 5μg/kg,group B was slowly sedated(time > 30s)with alfentanil 10μg/kg of the same volume as group A,and the control group was slowly sedated(time > 30s)with the same volume of normal saline.At the end of the examination,oxygen was administered via nasal cannula at a controlled rate of 3 L/min,and dexmedetomidine was pumped continuously in all groups during the examination.All examinations were performed intranasally,and surface anesthesia was administered with 2% lidocaine 3 ml acoustically at vocal cords and left and right bronchial tubes after entering the scope.If the patient develops a significant cough during the operation,an additional 1 ml of 2% lidocaine is sprayed.The patient’s response to bronchoscopy was evaluated by using the scoring table based on five different parameters,such as sleep state,sedation,respiratory response,body movement and facial expression,which was established by Umesh Goneppanavar,with 1-5 points for each item and a total score of 25 points.Record the comprehensive scores of sedation by bronchoscopy in three groups.The higher the score,the worse the sedation effect.When the score is greater than 15,midazolam1 mg is given intravenously for sedation.If the patient has HR<50 times//min during the examination,atropine 0.3-0.5mg can be given intravenously.Record the comprehensive score of bronchoscopy sedation when the bronchoscope passes through glottis and carina,and the changes of SBP,HR and Sp O2 when entering the room(T1),when dextromethorphan loading dose pumping is completed(T2),when entering the mirror to nasopharyngeal level(T3),when passing through carina(T4)and immediately after completion(T5).The dosage of lidocaine in operation and the number of cases of remedial midazolam and atropine in operation;Operation time,awakening time and leaving room time of each group;After the operation,the NRS score of pain in each group was given.And record the satisfaction of each group of operators with sedation during the operation.Results.1.There was no statistically significant difference in gender,age,BMI,ASAclassification,andtype ofexamination among the threegroups(P> 0.05).2.In the comparison of the Umesh sedation composite score of bronchoscopy at vocal cords and carina in the three groups,group B was significantly lower than group A and the control group,andthe difference was statistically significant(P< 0.05)3.In the comparison of heart rate(beats/min)and systolic blood pressure(mm Hg)at T3 and T4 inthe three groups,group B was significantly lower than group Aand the control group,and the difference was statistically significant(P< 0.05);however,in the comparison of oxygen saturation(%)at each time point in the three groups,the difference was not statistically significant(P> 0.05).4.The comparison of operation time,awakening time and leaving time of the three groups of patients was that the operation time of group B was shorter than that of group A and the control group,and the difference was statistically significant(P< 0.05);there was no significant differencein theawakening time and leaving timeof each group.5.The results of comparing the NRS scores of the three groups of patients showed that group B was significantly lower than group A and the control group,and the difference was statistically significant(P< 0.05).6.The comparison of operator satisfaction(%)inthe three groups was thehighest in group B and thedifference was statistically significant(P< 0.05).Conclusion.1.Dexmedetomidine compounded with alfentanil can be safely and effectively used in bronchoscopy.2.The application of dexmedetomidine compounded with alfentanil 10μg/kg in bronchoscopy not only does not increase the incidence of adverse reactions,but also reduces intraoperative stress,which makes the operation smoother and thus shortens the examination time,and at the same time reduces the pain level of patients during the examination and improves the satisfaction of operators. |
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