The Clinical Effect Of Dezocine On Anesthesia Emergence Agitation In Patient With Thoracic Surgery

Background and ObjectivesIn the awakening period of general anesthesia, the patients’physical and psychological function gradually recovery, and improper operation and a variety of adverse stimuli may lead to hemodynamic perturbations or patient restlessness, excitement, restlessness and directional barriers coexist, such as involuntary movements of the limbs, struggle, incoherent, irrational language, cry or moan, and delusional thinking. According to a large number of studies,the analysis indicated that a variety of noxious stimuli is the most common reason of inducing and aggravating anesthesia emergence agitation, of which the most important risk factor is postoperative pain. Esophageal cancer surgery has huge surgical trauma, severe pain, easily lead to the occurrence of anesthesia emergence agitation.Dezocine is the benzene morphine alkane derivatives, belong to a new hybrid receptor excited antagonist, the main excitement of the k receptor distribution in the brain, brainstem and the medulla oblongata, resulting in spinal analgesia, have a good and quickly analgesic effect after intravenous injection, a negligible effect on the respiratory and the mitigation of acute postoperative pain better than an equivalent dose of morphine effects. Dezocine excited-as opioid receptor and antagonists, has a satisfactory relief to opioid-induced hyperalgesia, and ideal analgesic effect on postoperative analgesic in propofol remifentanil anesthesia, thus effectively reducing the incidence of postoperative agitation.Numerous clinical studies have proven that dezocine can safely and effectively used in clinical anesthesia and postoperative analgesia, but there were rare reports about dezocine used in the prevention of general anesthesia agitation, this study aims to explore dezocine can efficacy and safety prevent anesthesia emergence agitation in the esophageal cancer surgery.Subjects and methodsNinety patients undergoing esophageal cancer surgery, age 30 to 65 years, weight 50～80kg, ASAI-Ⅱlevel, were randomly divided into three groups, three groups of patients were treated with tracheal intubation with propofol-remifentanil intravenous anesthesia, after routine induction of anesthesia, use the anesthesia machine mechanical ventilation after success intubation, and use micro-pump pumping propofol, cis-atracurium, remifentanil as a constant rate intravenous to maintain the anesthesia.20 min before the end of surgery, I group were injected with 0.9% sodium chloride intravenous injection 5ml, II group were intravenous injected with dezocine 2.5mg, III group were intravenous injected with dezocine 5mg. Record postoperative recovery spontaneous breathing time and extubation time; Record three groups of patients with heart rate, mean arterial pressure, arterial blood sample saturation changes at the end of surgery, the time of extubation and 10 min after extubation; Assessed the restlessness incidence and agitation score among three groups patients in the wakening period; observed postoperative respiratory depression, nausea, vomiting, lethargy and fever incidence of adverse reactions among three groups of patients; and compared the analgesic efficacy satisfaction of three groups patients family members in 24h.Results1. The differences of drug discontinuance to Spontaneous breathing recovery time (min),and the end of surgery to extubation time (min)were no statistically significant amang 3 groups patients (p> 0.05).2. There were no statistically differences in the heart rate, mean arterial pressure, arterial oxygen saturation change at the end of surgery, time of extubation and 10 min after extubation in the three groups of patients (p> 0.05), There were statistically significant differences in heart rate, mean arterial pressure at the time of extubation, 10 min after extubation, betweenⅠ,Ⅱand groupⅢ, (p<0.05.)3. The emergence agitation scores and agitation incidence rate inⅢgroup were less than that in groupⅠandⅡ, The differences between the two groups was statistically significant (p<0.05).4. Compared withⅢgroup,ⅠandⅡwere lower in the total adverse reaction rate,and the difference was significant (p<0.05). The total incidence of adverse reactions inⅡgroup, were less than in groupⅠ,but the difference was not statistically significant (p>0.05).ConclusionsIntravenous injection of dezocine 5mg,20 min before the end of thoracotomy surgery could reduce the occurrence of general anesthesia agitation in Remifentanil and propofol maintain anesthesia, so that patients’hemodynamic stabilized in the wakening period, the patients were more comfortable that does not affect extubation time, and help to reduce the incidence of postoperative PCIA Sufentanil adverse reactions.