The Effect Of Dexmedetomidine On Stress Reaction In The Pediatric Population Undergoing Surgery

Dexmedetomidine is a high selectivity of alpha2adrenergic agonist withanalgesic,sedative and anxiolytic properties. Dexmedetomidine-inducedhypnosis with the unique characteristic of can awaken, and similar to naturalsleep.Although initial product manual describes that the application ofdexedetomidine in the clinical data of children is limited,with the properties ofreduce stress reaction,reduce the quantity of other anaesthetic,and impact onbreath fection slightly,there were a large number of research withdexedetomidine in pediatric patients recent years.This study discuss theinfluence of dexedetomidine to the stress reaction and the postoperativeanesthetic revival period, dexedetomidine use in pediatric patients generalanesthesia and spinal canal anesthesia.So as to Provide reference for clinicalapplication.Partq1The effect of Dexmedetomidine on Stress Reaction in the pediatricPatients Undergoing Tonsillectomy and AdenoidectomyObjective: To evaluate the effect of Dexmedetomidine on stress reactionin pediatric population undergoing Tonsillectomy and Adenoidectomy.Methods: Forty children undergoing tonsil and adenoidectomy excisionwere randomly to receive Dexmedetomidine (group D)or control (group C).Inclusion criteria: ASA classification of Ⅰ,2-7years old,13-26kg. Exclusioncriteria: Congenital heart disease or arrhythmia, organ function obstacle, theupper respiratory tract infected recently, abnormal or intelligencedevelopment, above20%of standard body weight.Fasting8h, ban drink6h preoperative. Atropine0.01mg/kg intravenousinjection as premedication. Basic anesthesia using2mg/kg propofol+midazolam0.1mg/kg, Monitoring included pulse oximetry, electrocardiogram,BIS and arterial pressure. Group D received IV dexmedetomidine(1μg/kg over 10minutes, followed by0.7μg/(kg·h)until10minutes before the end of thesurgery). Anesthesia of group D was induced with IV midazolam0.2mg/kg,propofol2mg/kg, atracurium0.2mg/kg, sufentail0.3μg/kg andendotracheal intubation. But group C with sufentail0.5μg/kg.Group D IVdexmedetomidine0.7μg/(kg·h), remifentanil0.2μg/(kg·min), propofol4-6mg/(kg·h) as maintenance of anesthesia. And group C administered withremifentanil0.2μg/(kg·min), propofol6-8mg/(kg·h). BIS values maintain at50±5during operation，higher than55propofol was given0.5mg/kg, and BISvalues less than45dexmedetomidine or propofol was reduced.All patients record pulse oximetry(SpO2), heart rate(HR),BIS and meanarterial pressure(MAP) at base lineT0,tracheal intubation immediately T1,geton mouth gag immediately T2,operation finished T3,and tracheal extubationimmediately T4.Extraction for2ml arterial blood in the five times to determineblood glucose(GLU), adrenaline(E) and cortisol（COR）concentration. Allpatients were observed the time of breathing recovery and extubation.Results:1Between the two groups of patients age, gender ratio, weight and timeof operation, there were no significant difference(P>0.05).2There was no difference of each index in T0time between two groups.HR of T1,T4were higher than T0,but T1-T4in group D were lower than groupC(P<0.05). MAP of T1,T3in group D were lower than group C(P<0.05).Cortisol and epinephrine of T1and T4in group D were higher thanT0(P<0.05),but lower than group C(P<0.05).The two index of T1-T4in groupC were higher than T0(P<0.05).3The breathing recovery time of group D was shorter than groupC(P<0.05). The time of release from operating room of group D was longerthan group C(P<0.05).4Dosage of propofol in group D significantly less than group C(P<0.05).Conclusion: The use of Dexmedetomidene can maintain the stability ofthe patients hemodynamics, reduce the stress reaction of children, reduce theuse of other anaesthetic. Part2Administration of Dexmedetomidine in the children of sacral canalanesthesiaObjective: To evaluate the effect of dexmedetomidine on stress reactionin pediatric population of sacral canal anesthesiaMethods: Forty children undergoing hypospadias orthopedics wererandomly to receive dexmedetomidine (group d)or control(group p). ASAclassification ofⅠ，1-4years old,10-19kg, were eligible for inclusion in thestudy. Exclusion criteria: children with blood coagulation disorder, spinaldeformity and other congenital malformation, the spirit system disease, above20%of standard body weight.Fasting8h, ban drink6h preoperative. Atropine0.01mg/kg intravenousinjection as premedication. Basic anesthesia using2mg/kg propofol+midazolam0.1mg/kg，Monitoring included pulse oximetry, electrocardiogram,BIS and arterial pressure. Group d received IV dexmedetomidine((1μg/kg over10minutes, followed by0.5μg/(kg·h)until5minutes before the end of thesurgery).Group d IV dexmedetomidine1μg/kg over10minutes, followed by0.5μg/(kg·h) as maintenance of anesthesia, and group p IV propofol1mg/kgfollowed by2-4mg/(kg·h) as maintenance of anesthesia. BIS values maintainat60±5during operation，higher than65propofol was given0.5mg/kg, andBIS values less than55dexmedetomidine or propofol was reduced.All patients record pulse oximetry(SpO2), heart rate(HR),BIS and arterialpressure(MAP) at base line T0, pull the penis head T1,cut the skin T2,cut theurethral plate T3.Extraction for2ml arterial blood in the five time to determineblood glucose(GLU), adrenaline(E) and cortisol（COR）concentration.Allpatients were observed the time of anesthesia awake,postoperative agitationothe adverse reactions.Result:1Between the two groups of patients age, weight and time of operation,there were no significant difference(P>0.05).2There was no difference of each index in T0time between two groups. HR and MAP in group d T2,T3was lower than group p(P<0.05). Cortisol andepinephrine of group d in T1-T3was higher than T0(P<0.05).There was nodifference of two index in group d.3There were two cases of SpO2<92%in group p, after holding the chin,mask oxygen, the SpO2returned to normal.4The time of release from operating room of group d was longer thangroup p.5There were3cases occurred postoperative agitation in group p,andgroup d was not occurred. But no statistical difference(P>0.05).Conclusion: Dexmedetomidine administration in children sacral canalanesthesia can reduce stress action and little impact on breathing.