| Objective This study was carried out to observe the influences of dexmedetomidine on hemodynamics, stress levels, dosage of anesthetics, postoperative recovery time and cytokines of the elderly patients with total intravenous anesthesia during laparoscopic colorectal cancer surgery, so as to provide theoretical support to dexmedetomidine’s being applied on the elderly patients undergoing laparoscopic colorectal cancer surgery with total intravenous anesthesia. Methods 40 elderly patients between 65-80 years old and classified as ASA I-II, who received laparoscopic colorectal cancer surgery, were randomly divided into two groups, dexmedetomidine group(group D) and saline group(group C), each group included 20 cases. All the patients received total intravenous anesthesia. The patients of group D were infused the dexmedetomidine 0.4ug/kg in 10 minites before anesthesia induction and 0.4ug/(kg·h) during the maintenance of anesthesia, while the patients of group C with the same amount of saline. The rest of anesthetics during the induction and maintenance of anesthesia in two groups were the same. We adjusted the dosage of propofol and remifentanil during the maintenance of anesthesia according to the BIS(Bispectral index). Following data of the two groups were documented: Mean arterial pressure(MAP), heart rate(HR) in series of time points: arriving the operation room(T0), after infusion of loading dose of dexmedetomidine(T1), immediately after intubation(T2), 3 min after intubation(T3), the moment of pneumoperitoneum(T4), 60 min after pneumoperitoneum(T5), immediately after extubation(T6), 1 min after extubation(T7), 5 min after extubation(T8), 60 min after operation(T9). The serum cortisol was measured at the time points of T0-6. Interleukin-6(IL-6) and Interleukin-10(IL-10) were measured at the time points of T0, T9, and 24 h after operation(T10), 48 h after operation(T11). Recorded Ramsay sedation score(RSS) and Visual Analogue Scale score(VAS) at T7, T8, T9. Recorded the operation time, the total dosage of propofol and remifentanil, blood lost and recovery time. Results: 1. There’re no significant differences between the two groups before and during the operation in general(p>0.05). 2. MAP/HR: There’re no significant differences between the two groups at T0(p>0.05). At T1, Group D descended(p<0.05), while Group C didn’t. Compared with T0, there’er significant changes in Group C at T2-9(p<0.05), while no changes in Group D(p>0.05). At T1-9, each number of MAP and HR in Group C were higher than that in Group D(p<0.05). 3. Cortisol: There’re no significant differences between the two groups at T0(p>0.05). Compared with T0, there’er no significant changes in group D at T1 and T2(p>0.05). Compared with T0, the cortisol of group D significantly decreased at T3 and T5(p<0.05), but significantly increased at T4 and T6(p<0.05). Compared with T0, the cortisol of group C significantly increased at T2-6(p<0.05). The cortisol of group D was significantly lower than group C at T2-6(p<0.05). 4. IL-6/IL-10: There’re no significant differences between the two groups at T0(p>0.05). Compared with T0, IL-6 in both of the two groups significantly ascended at T9-11(p<0.05), while the Group D was lower significantly than Group C(p<0.05). Compared with T0, IL-10 in both of the two groups significantly accended at T9-11(p<0.05), while the Group D was significantly higher than Group C(p<0.05). 5. Recovery time/ Ramsay Score/ VAS Score: There’re no significant differences between the two groups in recovery time(p>0.05). The Ramsay score in Group D was higer significantly than that in Group C at T7-9(p<0.05). The VAS score in Group D was lower significantly than that in Group C at T7-9(p<0.05). 6. The dosage of propofol and remifentanil in Group D was lower significantly than that in Group C(p<0.05). Conclusion: 1. The dexmedetomidine’s being used in the elderly patients undergoing laparoscopic colorectal cancer surgery with total intravenous anesthesia can help reduce the cortisol release, relieve the stress reaction and keep the balance of hemodynamic. 2. The dexmedetomidine’s being used in the elderly patients undergoing laparoscopic colorectal cancer surgery with total intravenous anesthesia can help reduce the IL-6 release, increase the IL-10 release and keep the balance of the cytokines after operation. 3. The dexmedetomidine’s being used in the elderly patients undergoing laparoscopic colorectal cancer surgery with total intravenous anesthesia can help reduce the dosage of propofol and remifentanil, and increase the postoperative sedative effect and analgesia without delaying the recovery time. |
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