Clinical Application Of Dexmedetomidine-ketamine Balanced Intravenous Anesthesia In Cervical Conization

AIM Cervical conization is the preferred method for the treatment of cervical intraepithelial neoplasia（CIN）.It is simple,short-lived and less painful,and can be completed under intravenous anesthesia.Anesthesia with propofol combined with opioid analgesics is commonly used for anesthesia in this type of surgery,but both inhibit breathing and circulation.The respiratory cycle inhibition of propofol is dose-dependent,and propofol combined with opioids is prone to agitation,affecting patient safety and increasing the difficulty of anesthesia management.In this study,compared by intravenous anesthesia with propofol combined with sufentanil,to investigate the clinical efficacy and safety of dexmedetomidine combination with ketamine for cervical conization.METHODS A total of 60 ASA grade I-II patients were received cervical conization,aged 18 to 60 years,without sinus bradycardia,hypertension,severe second-degree and third-degree atrioventricular block,long-term use of epinephrineα₂ Receptor agonists and epinephrineβblockers,persons with increased intracranial or intraocular pressure,epilepsy or psychosis,and a history of allergies to narcotic drugs.The patients were selected and randomly divided into dexmedetomidine-ketamine group（D-K group,n=30）and propofol-sufentanil group（P-S group,n=30）by random number table method,with30 cases in each group.The D-K group was given dexmedetomidine(a bolus of 1mg·kg^-1,followed by 1.5mg·kg^-1·h^-11 infusion during the operation)and ketamine(a bolus of0.5mg·kg^-1,followed by 1mg·kg^-1·h^-11 infusion during the operation).In the P-S group,target-controlled infusion of propofol(the target plasma concentration was set at 3mg·L^-1)and sufentanil 0.15mg·kg^-11 was given.The heart rate（HR）,mean arterial pressure（MAP）,respiration rate（RR）,the observer’s assessment of alertness/sedation scale（OAA/S）,bispectral index（BIS）,pulse oxygen saturation（SpO₂）end-tidal carbon dioxide partial pressure(P_ETCO₂)were recorded at room admission（T₀）,up to BIS≤60（T₁）,surgery initiation（T₂）,intraoperative 10min（T₃）,intraoperative 20min（T₄）,and after operation（T5）.The anesthesia induction time,orientation recovery time,postoperative adverse reactions and postoperative 6h visual analogue scale（VAS）score,adverse reactions during and after surgery,and postoperative satisfactory degree of both operators and patients were all required to be observed and recorded.RESULTS In the D-K group,the patients maintained a stable intra-operative breathing,with SpO₂ maintaining above 99%,and P_ETCO₂ was kept at 35-45 mm Hg without respiratory depression.In the P-S group,SpO₂ was lower than that in the D-K group at T₁-T ₃,and the P_ETCO₂ was higher than that in the D-K group at T₂-T₅（P<0.05）.The incidence rate of respiratory depression was 80%（24/30）in the P-S group,and higher than that in the D-K group（P<0.05）.In the D-K group,the postoperative 6h VAS score was lower than that in the P-S group（P<0.05）,and the anesthesia induction time and orientation recovery time were longer than those in the P-S group（P<0.05）.The incidence rate of hypotension was 70%（21/30）in the P-S group and 3%（1/30）in the D-K group,and there was a significant difference（P<0.05）.There was no significant difference in operative time,and the satisfaction rate of both patients and operators between the two groups（P>0.05）.CONCLUSION Dexmedetomidine-ketamine can be safely used for anesthesia of cervical conization,which can better maintain hemodynamic stability,satisfactory anesthesia effect,and no significant inhibition on breathing during operation.The hemodynamics is stable during surgery with a well-maintained spontaneous breathing.The safety of such anesthesia that preserves spontaneous breathing is provided,but the recovery time of postoperative orientation is significantly prolonged.