The Effect Of Dexmedetomidine Co-administered With General Anesthetic On Hemodynamics And Recovery Quality In Laparoscopic Gastrointestinal Surgery

Objective: The goal of this study was to investigate the effect ofdexmedetomidine(Dex) co-administered with general anesthetic in laparoscopicgastrointestinal surgery, in order to provide a theoretical basis for clinicalanesthesia.Methods: Eighty patients aged forty to sixty years (ASAⅠ～Ⅱ),who werescheduled for laparoscopic gastrointestinal surgery, were randomly divided into fourgroups; namely propofol group (group P), sevoflurane group (group S),bothpropofol and Dex group (group PD),or sevoflurane and Dex group (groupSD),twenty patients were contained in every group. Before anesthesia induction,Dex were infused in groupPD and group SD (1μg/kg over10min followed by0.4μg/kg/h until the end of surgery). Dex was replaced by saline with same infusionmethod in group P and group S. Anesthesia induction, propofol1~1.5mg/kg,fentanyl2~4μ g, vecuronium0.1~0.15mg/kg were infused in all groups.Anesthesia maintenance, propofol or sevoflurane dosage were adjusted by entropyindex. Entropy index (RE and SE) was controled at forty to sixty, RE subtract SEshould be less than five. Four groups patients’ SBP, DBP, HR, PetCO2, SpO2andentropy index were observed at pre-anesthesia (T0), after anesthesia induction (T1),surgery begin (T2), surgery begin after30min (T3) and surgery over (T4). The timerequired of all groups’ entropy index recover from60to70,80,90points wererecorded when interrupt anaesthetic. The time required between interruptingatracurium to spontaneous breathing, eyes opening, fisting,and extubation wererecorded. The Analgesia and sedation score of all groups patients were measured byvisual analogue scale and Ramsay criterion after extubation. The averagemaintenance dose of propofol or sevoflurane were calculated at the end of surgery.Results:Hemodynamics: All groups’ SBP and DBP were significant decreased during T1 compared with T0(P＜0.05), and that the SBP and DBP of group PD and group SDwere decreased less than group P and group S. The levels of SBP or DBP in group Sand group SD were below than group P and group PD(P＜0.05). when at T4, thelevels of SBP and DBP in group S was significantly rised than others groups(P＜0.05). Patients in group PD and group SD were infused Dex at T1, the heart ratewere significantly decreased than T0(P＜0.05). The levels of heart rate in group PDand group SD were lower than group P and group S at T1~T4(P＜0.05). Recovery:When interrupt anaesthetic, the time of entropy (include RE and SE) respectivelyrecover from60to70,80,90points in groups PD were significantly slower thanothers groups(P＜0.05). There were no significant differences in requiring timebetween interrupting atracurium to spontaneous breathing, eyes opening,fisting,and extubation among the four groups(P＞0.05).Postoperative Analgesia and Sedation Score: The Ramsay sedation scores in groupPD and group SD were significantly higher than group P and group S(P＜0.05),the analgesia scores of patients in group PD and group SD were significantly lowerthan group P and group S(P＜0.05).Anesthetic maintenance dose: The average maintenance dose of propofol in groupPD was less than group P(P＜0.05), the average inhalation concentration ofsevoflurane in group SD was lower than group S(P＜0.05).Conclusion: There have dose-dependent effect on hemodynamics by Dex.Sevoflurane is more superior than propofol on BP controlling when co-administeredwith Dex. Bradycardia is caused by Dex, especially co-administered withremifentanil. Dex may delay recovery from propofol. The muscle relaxationrecovery does not be affected by co-administered with Dex. what’s more,satisfactory sedation and analgesia efficacy was provided by Dex. Under theguidance of entropy monitoring, Dex can reduce propofol or sevofluraneconsumption.