Dexmedetomidine For Postoperative Patient-controlled Intravenous Analgesia (PCIA) With Sufentanil In Patients With Essential Hypertention

Objective To evaluate the effect of dexmedetomidine as an adjuvant of PCIA with sufentanil in patients with essential hypertention and it's effects on hemodynamics.Patients and methods Sixty ASA II-III patients in our hospital (Shandong Provincial Hospital) in Gynecology with a history of essential hypertentionⅡ～Ⅲgrade for more than 1 years were included in this study.The patients ranged in age from 42-63 years and in body weight 48-72 kg and were scheduled for abdominal hysterectomy. General anesthesia for all surgical methods were used. Patients were randomly divided into 3 groups (A group, B group, C group, n=20).The patients received PCIA after operation. The patients of A group received PCIA(the PCA's formula was sufentanil 100ug+tropisetron 5mg and normal saline solution to 100ml) with intravenous normal saline infusion;the patients of B group received PCIA(the PCA's formula was sufentanil 100ug+tropisetron 5mg and normal saline solution to 100ml) with intravenous dexmedetomidine (Jiangsu Hengrui Medicine Co., Ltd.) infusion at 0.2ug/kg/h for 24h;the patients of C group received PCIA(the PCA's formula was sufentanil 100ug+tropisetron 5mg and normal saline solution to 100ml) with intravenous dexmedetomidine infusion at 0.3ug/kg/h for 24h. All the PCIA regimen included a background infusion at 2ml/h with a 0.5ml bolus dose and a 15 min lockout interval.After the patients back to the ward ECG, blood pressure, pulse oxygen were monitored. All the patients had a continuous oxygen inhalation via nasal catheter. Recorded the blood pressure (BP), heart rate (HR) oxygen (SpO2) respiratory rate (RR) before and after operation. Observed VAS pain score(0=no pain,10=worst pain) and Remesay sedation scores(1=wide awake,5-6=over sedated). The total number of button pressing(D) of PCA and the consumption of PCIA solution were also recorded.Results VAS pain score was significantly higher in group A than that in group B and C(P<0.05),and that was significantly higher in group B than in group C(P<0.05). Remesay sedation score in group C was the highest among the 3 groups, and that was higher in group B than in group A(P<0.05).The total number of button pressing (D) and the consumption of PCIA solution were significantly higher in group A than in group B and C (P<0.01).BP and HR were significantly decreased after operation in group B and C compared with the baseline value before anesthesia (P<0.05). Oxygen and respiratory frequency were no statistically significant in the three groups.Conclusion Dexmedetomidine as an adjuvant of PCIA with sufentanil can not only play good sedative effect, but also reduces arterial blood pressure, not increase respiratory depression, prevent deterioration of postoperative hypertension to prevent cardiovascular and cerebrovascular vascular accidents.