| The functional areas of brain lesions surgery could easily lead to severe neurological damage in patients, how to accurate position, to maximize the excision of the lesion, while protecting normal nerve function, is a problem that neurosurgeon facing. Neuronavigation and electrophysiological techniques to intraoperative nerve anatomy functional position can be avoided ribbon damage in patients with intraoperative manipulation sober, but the intraoperative wake-up put forward higher requirements for anesthetic management required in patients with lesion localization and removal process, in the awake state, to avoid anesthetic drugs interfere with neurophysiological monitoring and cerebral cortex nerve anatomy, functional location, cooperate with the surgeon make instruction reaction, and evaluating the condition of nerve function area. Propofol total intravenous anesthesia has waking up quickly and has a neuroprotective function, commonly used in the functional areas of brain lesions intraoperative wake-up. But its duration time and quality is often not be satisfied, and prone to cough, restlessness,which lead to increased intracranial pressure. Dexmedetomidine,the new, highly selective a2adrenergic receptor agonist, has dose-dependent sedation, analgesia, anti-anxiety, inhibition of the sympathetic nerve and brain protection role, no breathing inhibition, excited the central nervous system a2receptor which is the most intensive areas-brainstem locus coeruleus (responsible for the mediation of arousal and sleep), triggering and maintaining the natural non-rapid-eye-movement sleep (NREM) state, similar to physiological sleep that easy to wake up, fewer side effects. It is the ideal drug in the wake of the functional neurosurgery. Our country has rarely been reported, it still need to accumulate data. This study compared the safety, adverse reactions and wake-up quality of dexmedetomidine and propofol used in functional neurosurgery,valuation of dexmedetomidine used in motor function of nerve surgery intraoperative wake-up effect.Objective To compare the effectiveness of dexmedetomidine and propofol combined with remifentanil in intraoperative wake-up test during motor functional neurosurgery.Methods Sixteen patients, age18-65year,8males and8females, ASA I or Ⅱ, requiring intraoperative arousal test during functional neurosurgery were randomly divided into2groups. Wake-up test for location of brain domain was completed using dexmedetomidine combined with remifentanil (group A, n=8) or propofol combined with remifentanil (group B, n=8). Patients in two groups were used propofol, remifentanil TCI anesthesia induction, after endotracheal intubation, adjusting the propofol plasma concentration of TCI, to maintain the depth of anesthesia level performance of Narcotrend Stage (NTS) D2-E1, and according to the operative,need to adjust effect-site concentration of remifentanil2～6ng/ml. If surgeons remove the skull, stop infusing propofol,start to infuse the dexmedetomidine, given load0.8μg/kg15-minute steady intravenous injection. Followed by0.3μg·kg-1·h-1continuous infusion, according to the surgical procedures, remifentanil infusion need to be adjusted between2～6ng/ml. If ready to wake up, Group A be adjusted the infusion rate of dexmedetomidine as0.1μg·kg-1·h-1, to adjust the effect-site concentration of remifentanil between1～1.5ng/ml. If group B was prepared to wake up,adjusting the propofol target plasma concentration of0-1.5μg, adjusting the effect-site concentration of remifentanil1～1.5ng/ml until the NTS increased to BO,～B2, implementation of intraoperative wake-up. Hemodynamics, wake-up time, recovery time of spontaneous breathing and the number of body movement, the number of cough, responsingto commands, the incidence of intraoperative awareness, patient satisfaction surveys, surgeon satisfaction surveys were recorded. SPSS13.0were used to analyze the data. All data are reported as the mean±standard deviation.Comparisons between groups were made by student t-test. Comparisons of the patient’s blood pressure, heart rate were made by repeated measures analysis of variance, satisfaction surveys were compared using Wilcoxon rank sum test. Differences were considered significant at P<0.05.Results The two groups of patients’ gender, age, height, weight, body mass index showed no significant difference. Patients in group B required less time for wake-up and recovery of spontaneous breathing, and had more body movement, cough, compared with group A. SBP,MAP and HR in group B showed larger variation in intraoperative wake-up test compared with group A. Response to commands, the incidence of intraoperative awareness were no significant differences during awakening.Conclusion The dexmedetomidine used for neurosurgery motor function area intraoperative wake-up,it has a more stable hemodynamic,more safer and effective. Surgeons and their patients were more satisfied. The dexmedetomidine has obvious advantages compared with propofol.Objective To compare the effectiveness of dexmedetomidine and propofol combined with remifentanil in intraoperative wake-up test during language functional neurosurgery.Methods Sixteen patients, age18-65year,8males and8females, ASA I or II, requiring intraoperative arousal test during functional neurosurgery were randomly divided into2groups. Wake-up test for location of brain domain was completed using dexmedetomidine combined with remifentanil (group A, n=8) or propofol combined with remifentanil (group B, n=8). Patients in two groups were used propofol, remifentanil TCI anesthesia induction, after inserting laryngeal mask, adjusting the propofol plasma concentration of TCI, to maintain the depth of anesthesia level performance of Narcotrend Stage (NTS) D2-E1, and according to the operative,need to adjust effect-site concentration of remifentanil2-6ng/ml. If surgeons remove the skull, stop infusing propofol,start to infuse the dexmedetomidine, given load0.8μg/kg15-minute steady intravenous injection. Followed by0.3(μg·kg-1·h-1continuous infusion, according to the surgical procedures, remifentanil infusion need to be adjusted between2-6ng/ml. If ready to wake up, Group A be adjusted the infusion rate of dexmedetomidine as0.1μg·kg-1·h-1, to adjust the effect-site concentration of remifentanil between1～1.5ng/ml. If group B was prepared to wake up,adjusting the propofol target plasma concentration of0～1.5μg, adjusting the effect-site concentration of remifentanil1～1.5ng/ml until the NTS increased to BO,～B2, spontaneous breathings of patients restored and regained consciousness, unpluging the laryngeal mask,implementation of intraoperative wake-up. Hemodynamics, wake-up time, recovery time of spontaneous breathing and response to commands, the incidence of intraoperative awareness, patient satisfaction surveys, surgeon satisfaction surveys were recorded. SPSS13.0were used to analyze the data. All data are reported as the mean±standard deviation.Comparisons between groups were made by student t-test. Comparisons of the patient’s blood pressure, heart rate were made by repeated measures analysis of variance, satisfaction surveys were compared using Wilcoxon rank sum test. Differences were considered significant at P<0.05.Results The two groups of patients’ gender, age, height, weight, body mass index showed no significant difference. Patients in group B required less time for wake-up and recovery of spontaneous breathing compared with group A. SBP,MAP and HR in group B showed larger variation in intraoperative wake-up test compared with group A. Response to commands, the incidence of intraoperative awareness were no significant differences during awakening. Conclusion Application of the dexmedetomidine and propofol in intraoperative wake-up test during language functional neurosurgery is safe and effective, the dexmedetomidine in inhibition of throat irritations and stabling hemodynamics are superior to propofol.Objective To compare the effectiveness of dexmedetomidine and midazolam for agitated patients after extubation of general anesthesia, to evaluate of dexmedetomidine in the control of agitation.Methods Forty patients, age18-65year, male orfemale, ASA I or II, occurred agitation after general anesthesia, were randomly divided into2groups by sedative drugs used. Group D for dexmedetomidine, Group M for midazolam. Each group has20cases.After extubation, patients were done to be agitated score, who’s score in three points and above, needed to calm processing. Group D iv dexmedetomidine0.2u g/kg, group M iv0.05mg/kg, they both diluted into20ml, A doctor who don’t know the group iv drug into the forearm vein slowly, iv time last1minute. Record the MAP, HR, SpO2before and after the drug administration,And record OAA/S score and agitation score. SPSS13.0were used to analyze the data. All data are reported as the mean±standard deviation.Comparisons between groups were made by student t-test. Comparisons of the patient’s blood pressure, heart rate were made by repeated measures analysis of variance, score of OAA/S and agitation were compared using Wilcoxon rank sum test. Differences were considered significant at P<0.05.Results The two groups of patients’gender, age, weight showed no significant difference. MAP,HR and SpO2of patients in two groups showed no significant difference before the drug administration. After the drug administration5min, group D’s MAP. SpO2higher than group M’s. patients of groups D after the treatment of5min MAP has increased than before, HR has reduced; group M after the treatment of5min MAP, HR and SpO2than before has reduced.Score of OAA/S in group D showed no significant difference at time T1and T2. Score of OAA/S in group M T1 higher than T2.Conclusion The dexmedetomidine and midazolam have some effectiveness in patients who occurred agitation afer extubation, comprehensively consideration of efficacy, vital signs, depth of sedation, the dexmedetomidine superior to midazolam. |
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