The Effect Of Dexmedetomidine On Stress Reaction In Patients Undergoing Subtotal Gastrectomy

Objective: To evaluate the effect of dexmedetomidine on stress reactionin patients undergoing subtotal gastrectomy.Methods: Thitty patients undergoing subtotal gastrectomy wererandomly to receive dexmedetomidine (group D) or control (group C). In Dgroup dexmedetomidine was infused(0.5μg/㎏/h) during anesthesia inductionand all the surgery. The control group had to give the same amount of saline.And Two groups use the same anesthesia method, Anesthesia was inducedwith a target-controlled infusion (TCI) of propofol (effect site concentration,Ce;3mg/kg/h) and remifentanil (plasma concentration, Cp;5ng/ml). The Cecf TCI-propofol was adjusted to a Narcotrend index of45-55, and Cp ofTCI-remifentanil was fixed at5ng/ml in both groups. Mean arerial bloodpressure (MAP) and heart rate (HR), RPP, were recorded at before anesthesiainduction (T0), after the loading of study drugs10mins (T1), one min beforeanesthesia induction (T2),1min after tracheal intubation (T3), incision(T4),exploration (T5), and after tracheal extubation1min(T6), Recovery times andpropofol requirements were also recorded.And draw blood specimen in T0, T3,T4and T6to determine adrenaline and cortisol concentration.Result:1Between the two groups of patients age, gender ratio, body mass index,there were no significant difference, operation time between groups, wasstatistically significant (P>0.05).2①There wasno difference of each index in T0time in towgroups.②HRin group D T1-T5was obviously lower than the T0,Group D HRin T1，T3，T6below C group,(P<0.05).③MAP between group comparison: MAP in the T0state did not have obviousdifference. In group D MAP T2T4T5was obviously higher than that of the group C, P <0.05. In the group comparison: MAP in group D T2T4T5T6was obviously lower than the T0, C group was significantly lower thanT0inthe T2T4T5, P<0.05.③Δ MAP%and Δ HR%comparison：In T2, T3, T4Δ MAP%of group D was significantly lower than the group C. Δ MAP%ofgroup D in T1higher than C group, P<0.05. Δ HR%of Group D in the T1isobviously higher than that of the group C.3The dosage of propofol：dexmedetomidine group of propofol dosagewas significantly lower than the control group(P<0.05).4Two groups of patients with propofol Ce at various time points ofcomparison: the corresponding Ce value of D group significantly reducedcompared with group C (P <0.05).5Two groups of patients with various point Narcotrend value comparison:There was no significant difference comparison between the two grouppatients of Narcotrend value in T0. Group D Narcotrend value significantlylower compared with T0T1, T1of group D was lower than that in group C(P <0.05).6The comparison of the stress hormone: cortisol of dexmedetomidinegroup at each monitoring point was significantly lower than the control group,the control group at tracheal intubation time was obviously higher than that ofdexmedetomidine group (P<0.05) and epinephrine of dexmedetomidine groupduring intubation in comparison to basic value did not change significantly.7No obvious difference was found of decannulation time betweengroup D compared with group C, group D extubation time11±4minutes,9±3minutes of group C.Conclusion: The use of dexmedetomidine can maintain the stability ofthe patients blood circulation, reduce the propofol and other narcotic drug useso as to reduce high blood pressure or the side effects of bradycardia,Reducepatients of stress reaction, restrain the adrenaline and cortisol increases,shorten the recovery time and reduce postoperative analgesia drugusage.Dexmedetomidine may be an alternative to currently used adjunctiveanesthetic agents in operations.