Effect Of Intranasal Dexmedetomidine On Postoperative Awakening Quality、Recovery Quality And Postoperative Pain After General Anesthesia In Patients With Sleep Disorder

Background and Objective:Sleep disorder is one of the common problems which lead to a series of psychosomatic diseases.Preoperative sleep disorders may be aggravated by disease,hospital environment,fear of surgery and other factors.The patients with sleep disorder before operation had more pain and higher incidence of complications after extubation.Dexmedetomidine can simulate physiological sleep,analgesia,anti anxiety and stabilize hemodynamics,which is widely used in perioperative sedation and analgesia.Compared with conventional intravenous administration,intranasal dexmedetomidine is a relatively simple,noninvasive and mild route of administration,and avoids adverse hemodynamic changes caused by intravenous infusion.The purpose of this study was to observe whether there were differences in awakening quality,recovery quality and postoperative pain between patients with sleep disorders and without sleep disorders after general anesthesia.Objective to explore the effect of intranasal dexmedetomidine on awakening quality,recovery quality and postoperative pain after general anesthesia in patients with sleep disorders.Methods:A prospective study was conducted on patients who underwent thoracoscopic lobectomy under general anesthesia in our hospital from September 1,2020 to December 1,2020.All operations in this study were performed by the same treatment group.The inclusion criteria included:American Society of Anesthesia（ASA）Ⅰ-Ⅱ,18-65 years old,Body Mass Index（BMI）18-29 kg/m²;no preoperative history of hypertension,diabetes,heart disease,chronic obstructive pulmonary disease,asthma,brain trauma and brain surgery;no history of nasal surgery or nasal disease or nasal cavity deformities.Dexmedetomidine and otherα₂receptor agonists were not used in the past month.The patients were divided into sleep disorder group and non-sleep disorder group by Pittsburgh Sleep Quality Index（PSQI）before operation.Then they were divided into intranasal dexmedetomidine patients and equal normal intranasal saline patients.There are four groups:sleep disorder intranasal dexmedetomidine group（group A）;non-sleep disorder intranasal dexmedetomidine group（group B）;sleep disorder intranasal normal saline group（group C）and non-sleep disorder intranasal normal saline group（group D）.Routine preoperative preparation,anesthesia induction and anesthesia maintenance.Patients in group A and group B were given intranasal dexmedetomidine at a dose of2μg/kg 30 minutes before the end of the operation,and the total volume of the drug solution was 0.02ml/kg;patients in the group C and group D were given 0.02ml/kg of saline 30 minutes before the end of the operation.Record the indicators for assessing the patient’s awakening quality:extubation time,post anesthesia care unit（PACU）stay time,extubation complications;indicators for assessing the patient’s recovery quality:40-item questionnaire on quality of recovery from anesthesia（Qo R-40）score at 24 hours after operation;indicators for evaluating postoperative pain of patients:Visual Analogue Scale（VAS）pain score immediately after extubation and 4,8,12,and 24 hours after extubation and the total dosage of ketorolac tromethamine within 24h after extubation.The differences in awakening quality,recovery quality,and postoperative pain between patients with sleep disorders and non-sleep disorders were compared,and the effects of intranasal dexmedetomidine on postoperative awakening quality,recovery quality,and postoperative pain in patients with sleep disorders were analyzed.Results:1.A total of 83 patients were enrolled in this study,including 20 patients in group A,22 patients in group B,20 patients in group C,and 21 patients in group D.There was no significant difference in age,gender,BMI,ASA grade,operation time,anesthesia time,intraoperative amount of sufentanil citrate and the mean arterial pressure（MAP）and heart rate（HR）at time of entry（T1）,end of operation（T2）,and time of extubation（T3）among the four groups（P>0.05）.2.The quality of postoperative awakening and recovery of patients were compared,and the results showed that compared with patients in group D,patients in group C had a longer PACU stay time（P<0.05）.Compared with patients in group D,the extubation time and PACU stay time of patients in group B were significantly shorter（P<0.01）,and the Qo R-40 score of patients in group B increased at 24h after operation（P<0.05）.Compared with patients in group C,patients in group A had a shorter extubation time and PACU stay time,and a higher Qo R-40 score after surgery（P<0.01）.Compared with group C,the incidence of complications in group A was lower（P<0.05）.3.Comparing the postoperative pain of the patients,the results showed that compared with group D,VAS pain score increased at extubated immediately,4、8、12、24h after extubation increased,and the amount of ketorolac tromethamine at 24h after extubation increased（P<0.05）.Compared with group C,patients in group A had a lower VAS score at extubated immediately,4、8、12、24h after extubation,and the amount of ketorolac tromethamine was significantly reduced（P<0.01）.Conclusion:The quality of awakening and recovery of patients with sleep disorders after general anesthesia is poor,and the postoperative pain is more severe.Intranasal dexmedetomidine can improve postoperative awakening quality and recovery quality of general anesthesia patients.Intranasal dexmedetomidine can also relieve postoperative pain in patients with sleep disorders.