| Objective:To evaluate the efficacy of dexmedetomidine on isoflurane consumptions, end-tidal isoflurane concentration and perioperation, as an adjuvant to general anesthesia of isoflurane inhalation with continuous Narcotrend monitoring. It can provide the experience for clinical practice.Methods:Forty ASA I or II patients, scheduled for selective gynecological laparoscopy, female, aged18to65years old, weighing45-75kg, were recruited into this study with each group20cases. Patients in Group D (The dexmedetomidine experimental group) received a loading dose of dexmedetomidine0.5μg·kg-1for10minutes prior to induction and followed by0.5ug·kg-1h-1until30minutes before the end of surgery. While normal saline was given at the equal volume with the same method in group C (the saline control group). General anesthesia was induced with midazolam0.05mg·kg-1, fentanyl3μgkg-1, propofol1～2mg·kg-1, Vecuronium0.15mg·kg-1. When Narcotrend index<36, the patients received tracheal intubation and were mechanically ventilated and PET CO2was adjusted according to narcotrend index, which was maintained at37-64during operation..The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were recorded at the T1(awake), T2(10minutes after intravenous infusion of dexmedetomidine or normal saline),T3(immediately after tracheal intubation),T4(at the beginning of operation),T5(30 minutes after intravenous infusion of dexmedetomidine or normal saline),T6(60minutes after intravenous infusion of dexmedetomidine or normal saline) and T7(immediately after tracheal extubation) time point. Also the blood glucose was recorded at the T0(the day before operation), T4, T5and T6time point. Blood pressure, heart rate, the end-tidal isoflurane concentration,the hourly consumption of isoflurane,postoperative adverse reactions and other indicators were monitored and recorded. And the consumption of fentanly and propofol were compared in two groups.Results:The consumption of isoflurane in group C and group D were respectively15.24±2.82ml·h-1and10.52±3.08ml·h-1. Compared with group C, consumption of isoflurane in group D was significantly reduced (P<0.05). The end-tidal isoflurane concentration had significant difference at each time pointT4(0.94±0.21vs0.81±0.17), T5(1.16±0.19vs0.74±0.15) and T6(1.38±0.22vs0.65±0.14) between the two groups. Compared with group C, the blood glucose had significant difference at each time (T4,T5,T6) point between the two groups. And group D had little hemodynamic variation caused by tracheal extubation, and had stable blood glucose concentration. Also the percentages of patients suffering emergence agitation and delirium, postoperative nausea, vomiting, shivering in D group were markedly lower than C (P <0.05). The consumption of propofol in Group D was significantly lower than group C during induction of anesthesia (P<0.05). But for the consumption of fentanyl, the results showed that there was no statistical significance between two groups.Conclusion:Ajunctive use of an intraoperative dexmedetomidine in gynecological laparoscopy can save isoflurane requirements and decrease end-tidal concentration of isoflurane. It suggests that dexmedetomidine makes the perioperative hemodynamics more stable and with lower percentage of nausea, vomiting, chills, emergence agitation,pain and other adverse reactions which can improve the quality of recovery. So that low-dose dexmedetomide can improve the quality of recovery. While continued application of dexmedetomidine can effectively inhabit the peri-operative stress response and lower the levels of blood glucose. |
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