Preventive Effect Of Dexmetomidine Nasal Drops On Shivering In Patients Undergoing Cesarean Section Under Combined Spinal And Epidural Anesthesia

Objectives:To evaluate the preventive effect of dexmetomidine nasal drops on shivering in patients undergoing cesarean section under combined epidural anesthesia.Methods:From January to June 2018,one hundred and fifty cases of cesarean section under combined spinal anesthesia were selected from Taicang hospital affiliated to Suzhou university.ASA Ⅰ or Ⅱ patients aged 20～40y.Patients were randomly divided into 5 groups by random number table method(n=30):group D1,group D2,group D3,group C and group S.The patient takes the left supine position.Taking L3-4 as the puncture space of combined spinal anesthesia.After successful puncture,12.5 mg of saline ropivacaine injection with a weight of 0.5%was injected into the subarachnoid space.After the fetus is delivered and the umbilical cord is clamped.Group D1:Dexmedetomidine 0.5 ug/kg nasal drops;Group D2:Dexmedetomidine 1 ug/kg nasal drops;Group D3:Dexmedetomidine 1.5 ug/kg nasal drops;Group C:0.5 ug/kg dexmedetomidine was dissolved in 50ml saline at a rate of 5ml/min until the infusion was completed.S group(control group):normal saline nasal drip(0.01 ml/kg).The incidence and degree of chills(Wrench chills classification),sedation(Ramsay sedation score)and any adverse reactions such as sinus bradycardia,hypotension,hypoxemia were recorded after dexmedetomidine was used or after normal saline was dripped into the nose and out of PACU.Results:(1)There was no significant difference in basic data(age,height,weight,operative time,ASA grade)among the five groups(p>0.05).(2)Compared with group S,the degree and incidence of shivering was lower in group D1,D2,D3 and C,and the difference was statistically significant(p<0.05).The degree and incidence of shivering in group D1 was higher than that in group D2,D3 and C,The difference was statistically significant(p<0.05).There was no significant difference in the incidence and degree of shivering between group D2 and group C(p>0.05).The degree and incidence of shivering in group D2 and group C were higher than those in group D3,and the difference was statistically significant(p<0.05).(3)Compared with S group,the sedation score of group D1,D2,D3 and C was higher than that of group S.The difference was statistically significant(p<0.05).There was no significant difference in sedation score between group D1,D2 and C(p>0.05).The sedation score of group D3 was higher than that of group S,D1,D2 and C,The difference was statistically significant(p<0.05).(4)There was no significant difference in the incidence of hypotension in group S,D1 and D2(p>0.05).The incidence of hypotension between D3 group and C group was higher than thatof S group,D1 group and D2 group,The difference was statistically significant(P<0.05).There was no significant difference in the incidence of hypotension between group D3 and group C(p>0.05).There was no significant difference in the incidence of sinus bradycardia in group S,D1 and D2(p>0.05).The incidence of sinus bradycardia between group D3 and C was higher than that in group S,D1 and D2,the difference was statistically significant(p<0.05).There was no significant difference in the incidence of sinus bradycardia between group D 3 and group C(p>0.05).No hypoxemia was found in all the five groups.Conclusions:During cesarean section under combined spinal-epidural anesthesia,dexmedetomidine nasal drops with unit doses of 0.5 ug/kg,1 ug/kg and 1.5 ug/kg can effectively reduce the degree and incidence of shivering in patients,and can achieve sedation effect.Among them,the effect of 0.5 ug/kg nasal drops on shivering prevention is weaker than that of intravenous injection of the same dose.A dose of 1 ug/kg nasal drops has a good effect of suppressing the degree of shivering and reducing the incidence of chills,with moderate sedation,similar to the effect of intravenous infusion of 0.5 ug/kg dexmedetomidine,but the incidence of sinus bradycardia and hypotension is lower than that of intravenous infusion of 0.5ug/kg dexmedetomidine.1.5 ug/kg nasal drop has the best effect of suppressing chills and better sedation,but sinus bradycardia and hypotension are more common.Therefore,the 0.5-1.5 ug/kg dexmedetomidine nasal drops can effectively reduce the incidence of chills and reduce the degree of chills in cesarean section patients after hard waist combined anesthesia,improve the sedation score,and thus improve the comfort of patients,of which 1 ug/kg nasal drops are the best.