| Objective:We observed sedation, analgesia, hemodynamics, respi-ratory and amnesia under MAC using Dexmedetomidine and midazolam as adjuvant drug in order to evaluate effectiveness and safety of the dexme-detomidine and provide evidence for clinical application.Methods:We Select 40 patients in General Hospital of Shenyang Military Region who had a elective thyroidectomy.19 cases were male and 21 cases were female,age was 37-60 years old,weight was 58kg-85kg,height was 157-178cm. According to random number table, patients were randomly divided into the dexmedetomidine group (group D) and midazolam group (group M).In group D, dexmedetomidine at 1μg/kg was given to patients introveniously in 15 minutes. After loaded the bolus, patients were given continuous infusion at 0.1-0.7μg/kg/h dose. The initial infusion rate was 0.4μg/kg/h. In the liquid infusion process, according to Ramsay sedation scale, we observed sedation level of patients every 1 minute, and adjusted infusion rate 0.1μg/kg/h every 10 minutes in order to achieve Ramsay Sedation scale 3. If before the end of the boles, the patients achieved the Ramsay sedation grade 3 or above, stopped loading infusion, directly turned into continuous infusion. The infusion stoppd 10 minutes before the end of surgery, patients in group M were given midazolam intravenous at 30-40μg/kg, when the patients didn't achieved the level 3 of Ramsay sedation or less than Ramsay grade 3 in surgery, patients were supplemented midazolam 20μg/kg intravenously, the interval time between both intravenous administration not less than 10 minutes. As in the group D did, we observed patients'sedation level once every 1 minute. the total amount of midazolam in Surgery was no more than 10mg. Drug wan't addied to the patients 10 minutes before the end of surgery. The operation was promitted when the patients achived Ramsay score 3. Lidocaine(0.25%-0.5%) were used for local infiltration anesthesia of patients,additional infiltration anesthesia was applied to the patients when analgesia was incomplete. Surgery were operated by the same operator with conventional operation method. The monitoring of heart rate (HR), blood pressure (BP), respiratory rate (RR), pulse oxygen saturation (SpO2) and the depth of sedation continued until the patients leave the operation room. Adverse reactions were recorded in operation.The index were recorded at the diffent time point including previous operation(T0), skin incision (T1), the stripping of thyroid (T2), resection of the thyroid (T3), the sewing skin (T4) and left the operating room (T5). After surgery followed by the cooperation rating, the analgesic effect overall impression score, analgesic, sedation score and forgotten assessment. The data obtained were statistically analyzed.Results:The oxygen saturation and the respiratory rate in two groups at diffent time points were no significant difference(P>0.05); mean arterial blood pressure in group D is lower than that in group M at time point T2 and T3(P<0.05); mean arterial blood pressure in the group M at T2 and T3 was higher than that in the same group at To(P<0.05);the heart rate in group D at time point from T1 to T5 was lower than group M (P<0.05); the degree of cooperation in both groups had no statics significance(P>0.05);the degree of amnesia in group M was better than group D(P<0.05); there are two cases with mild respiratory depression in group M, two cases of hypertension, tow cases of tachycardia, two cases of irritability in group M, there are two patients of bradycardia, one case of hypertension and two cases of hypotension, the incidence of adverse events in group dexmede-tomidine was lower than group midazolam (P<0.01).Conclusion:Dexmedetomidine can be used for MAC effectively and safely; the hemodynamics of patients with dexmedetomidine is more stable compared with midazolam in Thyroidectomy under local anesthesia, inci-dence of adverse events of patients with dexmedetomidine is lower than patients with midazolam.
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