Clinical Study Of Target Controlled Infusion Of Propofol And Remifentanil Combined With Dexmedetomidine For Endoscopic Sinus Surgery

Objective: To observe the effects of different doses of dexmedetomidine combined withpropofol and remifentanil target controlled infusion on perioperative hemodynamics,stress response of petients in functional endoscopic sinus surgery and postoperativerecovery after anesthesia.Methods: Eighty ASA I or II patients, scheduled for the endoscopic sinus surgery, weredivided randomly into four groups, controlled group (C),0.3μg/kg/h dexmedetomidinegroup (D1),0.6μg/kg/h dexmedetomidine group (D2) and0.9μg/kg/h dexmedetomidinegroup (D3). Group D1-3were administrated with0.6μg/kg dexmedetomidine as loadingdose, and then administrated with dexmedetomidine in different maintenance dosesduring the anesthesia. All patients were performed target controlled infusion propofoland remifentanil during the maintenance of general anesthesia, rocuronium wasadministrated intermittently, BIS value was controlled at40-50. MAP, HR and BIS wererecorded before administration of dexmedetomidine (T0), before induction(T1),1minuteafter intubation(T2),5minute after intubation(T3), before extubation(T4) and5minuteafter extubation(T5). Blood loss and operative field score were evaluated. The cortisol,adrenaline and glucose in blood plasm were tested. The amounts of propofol andremifentanil were calculated. The spontaneous breathing recovery time, eye-openingtime, waking up time, extubating time, the adverse reaction of patients after surgery werealso recorded. Moreover, make use of visual analogue score and Ramsay sedation scoreto evaluate the comfort level of patients.Results:1. Hemodynamic: The MAP, HR after intubation were significantly higher thanbefore intubation in group C(P＜0.05). The MAP, HR in group D1-3maintained arelatively stable level during the anesthesia. At all time points, the HR in group D3wassignificantly lower than group D1-2and group C(P＜0.05). At the time point of5minuteafter extubation(T5), the MAP, HR in four groups were higher than the baseline(P＜0.05), and the MAP in group D2and group D3were significantly lower than group C andgroup D1(P＜0.05), and the HR in group D3was significantly lower than group D1-2andgroup C(P＜0.05).2. Biochemical indicators: The Corticosteroid, Adrenaline and Glucose in group C were significantly higher than the baseline at each time point after intubation(T3) and afterextubation(T5)(P＜0.05). At the time point of5minute after extubation(T5), theCorticosteroid, Adrenaline and Glucose concentration in group D1were significantlyhigher than group D2-3, and the difference was statistically significant(P＜0.05).3. Blood loss and operative field score: Fromme surgical field quality rating has nosignificant difference(P＜0.05) in these four groups, but the blood loss in group D1-3were significantly less than group C(P＜0.05). The comsuption of propofol andremifentanil in group D1-3were significantly less than group C(P＜0.05).4. Anesthesia recovery: The breathing recovery time, eye opening and extubation timeslightly extended in group D1-3, but it was not statistically significant compared withgroup C(P＜0.05). At the time point of15minute after extubation, the visual analogscores in group D1-3were significantly lower than group C(P＜0.05), while the Ramsaysedative scores were higher than group C(P＜0.05). Although the agitation and chillswere reduced in group D1-3(P＜0.05) compared with group C, the incidence ofbradycardia and respiratory depression in group D3increased. And the satisfaction of thepatients with anesthesia in group D1-3were significantly higher than group C(P＜0.05).Conclusions:1. Application of dexmedetomidine in endoscopic sinus surgery undergeneral anesthesia could stabilize perioperiative hemodynamaics, provide a goodsurgical field quality, and enhance the comfort level of patients after anesthesia.2. Continuous intravenous infusion of dexmedetomidine could effectively decrease thevalue of propofol and remifentanil by using target controlled infusion during anestheticmaintenance period, and reduce stress response during operation.3. The0.6μg/kg/h dose of dexmedetomidine could stabilize the hemodynamic, andinhibit the stress response and adverse events more effectively, but not influence theanalepsia and ectubation time of patients. In conclusion, this medicine is suitable as anadjuvant drug for patients undergone endoscopic sinus surgery.