Comparison Of Airway Stress Response And Arterial Blood CO₂ Concentration Between Dexmedetomidine And Midazolam In General Anesthesia Of Intubation

Background:Endotracheal intubation is the insertion of an endotracheal tube into the airway of a patient through the oral cavity or nasal cavity to ensure the patient’s airway is unobstructed.It is often used in some surgical operations or risk of aspiration in clinical practice.It is difficult to maintain the airway patency and mask.Patients who need to control their breathing for a long time are an important way to ensure the safety of patients。However,some patients need to undergo tracheal intubation to control the breathing,because of the relatively thick neck,large tongue size and congenital pharyngeal stenosis,etc.,when the tracheal intubation,the receptors of the epiglottis,tongue and neck muscles,The airway mucosa is activated by strong external mechanical stimulation and activates the sympathetic-adrenal system-angiotensin to trigger sympathetic nervous system excitation and reflexes,which can cause severe stress response after intubation.Stress response not only increases the risk of tracheal wall injury,but also can cause reflex rhythm increase,blood pressure,myocardial oxygen consumption increased significantly,and eventually may evolve into inflammatory response,myocardial ischemia,hypoxia to serious complications of heart failure or cardiac arrest.Therefore,how to choose appropriate sedatives,analgesics,muscle relaxants,and inhibit and relieve the stress response caused by intubation is of great significance to improve the prognosis of patients and ensure the safety of patients.Midazolam is an anesthetic commonly used in endotracheal intubation and has a sedative effect.However,as the dose of midazolam increases,it will increase the incidence of heart and respiratory depression,thereby affecting the expected anesthesia.Calm effect.Studies have shown that dexmedetomidine is effective in intubation for general anesthesia,which can reduce airway stress response and arterial blood CO₂concentration,but this conclusion needs to be verified.Objective:To investigate the airway stress response of dexmedetomidine and midazolam injection in general anesthesia and its effect on arterial blood CO₂concentration,and provide evidence for the rational application of dexmedetomidine and midazolam.And reference.Methods:58 patients who underwent general anesthesia for general anesthesia who were admitted to hospital from February 20 to February 2018 were randomly assigned to the midazolam group（n=26 cases）and the dexmedetomidine group.（n=32 cases）.Dynamic monitoring of two groups of pre-anesthesia（T0）,pre-intubation（T1）,intubation immediately（T2）,1 min after intubation（T3）,3 min after intubation（T4）,and 5 min after intubation（T5）heart rate（HR）,mean arterial blood pressure（MAP）,blood oxygen saturation（SPO₂）levels;recorded and counted T0,T1,T2,T3,T4 and T5 time point perfusion index（TPI）levels;using enzyme-linked immunosorbent assay.The levels of epinephrine（E）,norepinephrine（NE）and cortisol（Cor）were measured.The levels of T0,T3 and T5 were measured by enzyme-linked immunosorbent assay（ELISA）,and interleukin-1β（IL-1β）was measured.Interleukin-6（IL-6）and tumor necrosis factor-α（TNF-α）levels;blood gas analyzer was used to measure CO₂ concentration in arterial blood at T0,T3,T5 time points;comparison of anesthesia effect,safety and correspondence between the two groups.The effect of stimulatory response and arterial blood CO₂ concentration.Results:（1）The HR levels at the T1,T2 and T3 time points in the dexmedetomidine group were lower than those in the midazolam group（P<0.05）;the MAP level in the dexmedetomidine group was lower than the midazolam group.There were no significant differences in the levels of SPO₂ between the dexmedetomidine group and the midazolam group at the T0,T1,T2,T3,T4,and T5 time points（P>0.05）.（2）Right the TPI levels at the T1 time of the metopidine group and the midazolam group were higher than those of the T0,T2,T3,T4,and T5 time points（P<0.05）.（3）The T3 and T5 times of the dexmedetomidine group.The level of hormones in E,NE and Cor were lower than those in midazolam（P<0.05）.（4）The concentration of IL-1β,IL-6 and TNF-αin arterial blood at T3 time in dexmedetomidine group.Both were lower than the midazolam group（P<0.05）.Conclusion:The use of dexmedetomidine for general anesthesia in intubation has little effect on the hemorheology of the body compared with midazolam;it helps to reduce the stress response indicators E,NE,Cor hormone and IL-1β,IL-6,TNF-αlevels,maintaining safe arterial blood carbon dioxide concentration,and high drug safety,it is worth promoting.