Clinical Application Of Dexmedetomidine In Tracheal Stent Implantation With I-gel Laryngeal Mask Ventilation

Objective To investigate the changes of hemodynamics,the dosage of anesthesia,the changes of perioperative ventilation function and the changes of ventilation function in patients with tracheal stenting before general anesthesia.Anesthesia awakening time and the occurrence of postoperative adverse reactions,to explore the role of dexmedetomidine in I-gel laryngeal mask ventilation under the tracheal stent implantation in the application of the effectiveness and safety.Methods Forty patients with elective tracheal stenting were selectedin The Affiliated Hefei Hospital of Anhui Medical University,aged from 38 to 69 years,there were 24 male patients and 16 female patients with a total of 40 cases,and ASA grade Ⅱ orⅢ,operation time of all patients were not more than 1 hours,all patients were fasted before operation.The patients were randomly divided into two groups(n = 20):dexmedetomidine group(group D)and control group(group C).D group was injected with dexmedetomidine 1mg/kg within 10 minutes before anesthesia induction,then I-gel laryngeal mask was placed after anesthesia induction,andgroup C was injected with the volume of saline within 10 minutes before anesthesia induction,then I-gel laryngeal mask was placed after anesthesia induction.After induction,connected the ventilator to mechanical ventilation,adjust the amount of anesthetic to maintain the BIS value between 45-55.HR and MAP were recorded in baseline(T0),immediatelyafter induction of anesthesia(T1),immediately after tracheal stent implantation(T2),immediately after operation(T3),immediately after extubation(T4),and the consumed dose of propofol and remifentanil;Pa O2 、 Pa CO2 、 Sp O2 were measured before operationand one hour postoperatively,6hours postoperatively and 24 hours postoperatively;The time of extubation,recovery time and the incidence of agitation during recovery period were observed;The incidence of postoperative nausea and vomiting was observed;within 48 hours after follow-up patients,chest radiography and bronchoscopy to observe whether the stent shift.Results1.General clinical data: there was no significant difference between two groups on general clinical data(P> 0.05);2.Compare with T0 time,the HR of group D was significantly slower than that in group C at T2 ~ T4(P<0.05),and MAP was significantly higher than that in group C at T2 ~T4(P< 0.05).There was no significant difference between HR and MAP at each time point in group D(P> 0.05).3.In group D,the dosage of propofol and remifentanil,the time of extubation and recovery time were significantly lower than those in group C(P<0.05).The number of patients with agitation during anesthesia recovery period and the incidence of agitation in group D were significantly lower than those in group C(P<0.05).4.Compared with the preoperative,postoperative 1h,6h,24 h two groups of patients with Pa O2,Sp O2 increased,Pa CO2 decreased(P<0.05);group D and group C of patients before surgery,postoperative 1h,postoperative 6h,Pa O2,24 h after Pa CO2,Sp O2 compared difference was not statistically significant(P>0.05).5.The incidence of nausea,vomiting and regurgitation in group D was significantly lower than that in group C(P<0.05).6.Patients were followed up within 48 hours postoperatively,observechest radiography and bronchoscopy.One patient in group C had tracheal stent displacement within 24 hours postoperatively,and no stent shift occurred in group D within 48 hours postoperatively.Conclusion Pretreatment of dexmedetomidine can reduce hemodynamic fluctuations in I-gel laryngeal mask ventilation,reduce intraoperative narcotics,reduce anesthesia recovery time,reduce the incidence of postoperative adverse events,and does not affect the patient’s ventilation function improvement,the anesthesia program is reliable and effective and high security.