| Background:Dexmedetomidine is an α2specific adrenergic receptor agonist with dosage dependent sedative and analgesic effects, which can reduce the anesthetics dose required for surgery. It blocks sympathetic outflow and decreases stress response by activating central and peripheral a2receptors. The present study is aimed to understand the hemodynamics of dexmedetomidine infusion during the operation of Highly selective surgical resection of epileptic foci, and its effect on anesthetic dose requirements, stress responsive factors, as well as the patient’s postoperative cognition level.Method:Forty epilepsy patients from18to45years old had Highly selective surgical resection of epileptic foci at The Second People’s Hospital of Hunan Province. The all patients were randomized into two groups with20in each. Patients in the experiment group (group D) were first infused with dexmedetomidine0.6μg/kg for15minutes and switched to0.4ug/kg/h until the end of the surgery. In the control group (group C),these patients were infused withe quivalence saline. Patients in both groups were induced with Midazolam (60ug/kg),propofol (1mg/kg), Fentanyl (3ug/kg), Atracurium (0.06mg/kg) prior to tracheal intubation and mechanical ventilation. All the patients were receiving IV anesthesia during the surgery procedure and propofol was continuously pumped into IV, with Atracurium and Fentanyl added to maintain muscle paralysis and analgesia, respectively. Respiratory index was used for appropriate adjustment with the mechanical ventilation during the whole operation.Urine,hemorrhage and infusion were recorded during the surgery. Dosage of anesthesia was adjusted according to hemodynamic index and AEP index to maintain blood pressure within±20%of the baseline, and ephedrine was added if blood pressure fell below20%of the baseline. All patients were administrated with Sufentanil lug/kg plus Tropisetron5mg IV infusion (diluted with80ml saline). Blood was drawn from the body side without IV infusion T1(prior to the surgery),T2(after anesthesia induction), and T3(when anesthesia was stopped), and the levels of glucose and cortisol were simultaneous measured. Neuropsychological tests was tested by utilizing WMS and WAIS one day before and seven days after the surgery, respectively. Postoperative cognitive dysfunction definition was based on Z-combined score recommended by postoperative cognitive dysfunction-a Z-combined score greater than1.96or at least two Z scores from individual tests confirms diseased.Results:1.There were no significant differences (p>0.05) between the both groups in general information.2.The blood loss,infusion volume and Atracurium consumption in operation, were no significant difference, while Fentanyl and Propofol consumption in group D was less than group C (p<0.05).3.The cortisol decreased significantly after the anesthesia induction in group D compared to group C.4.The percentage of patients postoperative cognitive dysfunction was30%and5%in group C (6/20)and D(1/20) respectively,group C was higher than group D(p<0.05).Conclusion:1.This study showed that dexmedetomidine used in Highly selective surgical resection of epileptic foci could decrease the incidence of postoperative cognitive dysfunction in forepart stage.2.The drug of dexmedetomidine, could reduce the consumption of Fentanyl and propofol in Highly selective surgical resection of epileptic foci.Graph1,Table10,Feferences48. |
PDF Full Text Request