Effect Of Different Doses Of Oxycodone Hydrochloride Acting On The Postoperative Cardiovascular Responses Of Patients Undergoing Orthopedic Surgery During Extubation Under General Anesthesia

ObjectiveTo observe the effect of two different doses of oxycodone hydrochloride actingon the postoperative cardiovascular responses of patients undergoing orthopedicsurgery during extubation under general anesthesia and explore the appropriatel doseof oxycodone hydrochloride at extubation.MethodsNinety patients undergoing electively orthopedic surgery under generalanesthesia in China-Japan Union Hospital Of Jilin University between May andDecember in2014,were randomly equally divided into group O1, group O2and groupC.After three groups of patients went into the operation room,the peripheral venouspathway should be conventionally opened and be connected with monitor,includingsystolic blood pressure(SBP),diastolic blood pressure (DBP), pulse oxygen saturationpartial pressure (SPO2), electrocardiogram（ECG），end-tidal carbon dioxide partialpressure (PETCO2). The three groups of patients were treated with the same method ofanesthesia.Group O1and group O2were slowly intravenously given oxycodonehydrochloride0.1mg/kg and0.15mg/kg in12min at the end of surgery respectively,while group C same volume physiological saline. SBP,DBP,HR and SPO2weremonitored and recorded before induction(T0),at the end of surgery (T1),at extubation(T2),5min after extubation(T3) and10min after extubation(T4).To count up the timeof starting breathing,time of eyes opening and time of extubation.To evaluate theagitation score after operation (RSS) and visual analogue scale (VAS) of three groupsof patients at T3and T4. ResultsT2T4, SBP, DBP, HR of group C were significantly higher than those in T0(P <0.05),while group O1and O2were significantly lower than those in group C(P <0.05). At T3and T4, RSS score and VAS score of group O1and O2were significantlylower than those in group C(P <0.05).The number of cases of adverse reactions,including nausea, vomiting,sleepiness and inhibition of respiration of group O1and Cwere significantly smaller than those in group O2(P <0.05).The time of startingbreathing,time of eyes opening and time of extubation of group O1and C weresignificantly shorter than those in group O2(P <0.05).ConclusionThe success of tracheal extubation during the patient’s emergence from generalanesthesia is critical.The extubation response can elicit undesirable cardiovascular andairway reflexes and increase BP，HR，intracranial hypertension and/or intraocularhypertension，potentially leading to increases the rate of serious complicationsincluding laryngospasm, negative-pressure pulmonary edema and bleeding at thesurgical site. Currently, several methods are used to inhibit the extubation responseduring emergence, including deep extubation and the injection of lidocaine or opioids.However，the advantages of these methods are offset by the potential for upper airwaycomplications after extubation.Postoperative patients undergoing orthopedic surgeryhave the characteristics such as the large wound area, the deep location, the woundcompressed directly and soft tissue damaged severely, so the pain is more commonand intense,and is more likely to cause the stress response of body duringextubation,causing fluctuations of hemodynamics. Oxycodone is a semisyntheticopioid receptor agonist that is increasingly being used by mouth and i.v. for acute andchronic pain management.Through this clinical trial,we find that oxycodonehydrochloride intravenously given at the end of surgery can effectively maintain thestability of postoperative hemodynamics undergoing orthopedic surgery duringextubation under general anesthesia,and setting the dose for0.1mg/kg compared with0.15mg/kg, can not only reduce the incidence rate of adverse reactions, but also notprolong the time of starting breathing and time of extubation.So it is more suitable forclinical applied dose.