Clinical Study On Dexmedetomidine Attenuating Emergence Agitation After Gynecological Laparoscopy Under General Anesthesia

Objective: To evaluate the clinical effectiveness of dexmedetomidinein attenuating agitationin patients recovering from anesthesia in gynecological laparoscopic operationMethods:80 cases of gynecologic laparoscopic surgery, ASA I-II, were randomly divided into dexmedetomidine treatment(D) group and control(C) group(n=40). Patients in operation room received venous transfusion, radial artery puncture to monitor invasive arterial blood pressure(IAP), ECG, HR, routine monitoring of Sp O2, Pet CO2 and BIS values. All patients were given midazolam0.04mg·kg-1, sufentanil0.5μg·kg-1, etomidate0.3mg·kg-1,and rocuronium0.6mg·kg-1 given by endotracheal intubation, anesthesia was maintained with sevoflurane1%~3%, propofol2 ~ 4 mg·kg-1·h-1, cisatracurium0.05 ~ 0.1mg kg-1· h-1via inhalation, continuous infusion of cisatracurium to maintain muscle relaxation, breathing adjustment and ventilation controlled via IPPV, to maintain Pet CO2 between 35~45mm Hg. Dexmedetomidineadministered directly, after tracheal intubation, group D received an intravenous maintenance dose of dexmedetomidine at0.3μg·kg-1·h-1. Group Creceived an intravenous infusion of normal saline at the same rate. Intravenous anesthesia dose titrated during operation according to the MAP, HR and BIS values to maintain a BIS valuebetween 40 ~ 60, and to maintaina MAP value within 25% of baseline value. When large hemodynamic fluctuation occur, vasoactive drugs were given to maintain stability. At the end of the operation, during irrigation of operating field, the infusion of dexmedetomidine or normal saline were stopped, pump deliveringatracurium was stopped, sevoflurane was stopped. Laparoscopic instruments were withdrawn, propofol infusion was stopped at time of suturing. After indications for extubation were met, extubation occurred, patient transported to PACU.Amount of propofol, sufentanil used interaoperatively were recorded, recovery time from time medications stopped to waking, to spontaneous breathing, to eye opening, to extubation, to orientation were recorded. MAP, HR, Sp O2 changes at T0(at the end of operation), T1(extubation time), T2(5min after extubation), T3(10min after extubation) were recorded. Patients’ SAS score for sedation and agitation assessed at T1, T2, T3 time points,VAS scores assessed at T2, T3 time points. Record the incidence of intraoperative hypotension, bradycardia, restlessness, nausea and vomiting, respiratory depression and other complicationsResults: 1. Comparison of general Preoperativesituation: there was no significant difference in age,height, weight, operation time, anesthesia time and amount of bleeding and other general differences between the two groups(P>0.05), therefore comparable. 2. Comparison of anesthetic medication usage during operation: intraoperative anesthesia maintained with propofol in group D was 340.38±20.98 mg, group C was 430.12±31.21 mg, group D was significantly lower than that in C group(P < 0.05). The consumption of sufentanil, group D with an average of 53.34±4.78μg;in group C, average 69.18±5.12μg, D group were significantly lower than those in C group(P < 0.05). 3. Comparison of MAP recovery period and HR: there was no significant difference in MAP, HR in D group at each time point and T0(P > 0.05). In group C, MAP, HR was higher at T1, T2 than at T0, the difference was statistically significant(P < 0.05); at time points T1, T2, MAP and HR in group D were lower than group C(P < 0.05).4.Comparison of Sp O2 recovery period: Sp O2 were in the normal range for both groups at allrecovery periodtime points, no significant difference found within/between groups(P > 0.05).5. Comparison of SAS/VAS score during recovery: compared with group D, group C showed prolonged recovery time to spontaneous breathing, eye opening, extubation and orientation(P < 0.05). In group D, the recovery period of the SAS,VAS scores were lower than those in group C(P < 0.05).Comparison of adverse reaction: compared with group C, group D showed decreased hypotension, bradycardia(P < 0.05). compared with group C, group D showed decreased agitation incidences during recovery period(P < 0.05). The two groups had no statistically significant difference in PONV,shivering and respiratory inhibition.(P > 0.05).Conclusion:Gynecologic laparoscopic surgery under general anesthesia with continuous infusion of dexmedetomidineat 0.3μg·kg-1·h-1 during intravenous period can maintain stability in operation period, reduce cycle fluctuation during recovery, reduce the incidence of agitation in recovery, does not prolong the recovery time and extubation time with no significant adverse reactions, improving the quality of anesthesia recovery.