Effect Of Desflurane And Sevoflurane On Hemodynamics During Cleft Lip And Palate Operation In Children

Objective:With the improvement of living standards in modern society and the improvement of medical technology,children with cleft lip and palate have an increasingly strong desire for the recovery of lip and lip function,so the age at which children with cleft lip and palate receive surgery is also correspondingly earlier.In this study,the effect of desflurane and sevoflurane on hemodynamics during cleft lip and palate surgery in children was observed and compared,and the possible mechanism of its occurrence was further explored,so as to provide new ideas and schemes for clinical application.method:A total of 40 children with cleft lip and palate repair were selected from June2017 to October 2019 in Jiujiang First People’s Hospital.According to the random number table method,the subjects were divided into group D and group S.Group D was treated with desflurane and remifentanil to maintain anesthesia.Group S(n = 20)was anesthetised with sevoflurane and remifentanil.Group D was anesthetised by inhalation of desflurane and oxygen flow of 1.5L /min,and remifentanil hydrochloride was continuously pumped 0.5-1.0ug/kg/min to maintain anesthesia.During operation,sevoflurane inhalation anesthesia and 1.5 L/min oxygen flow were used in group S,and remifentanil hydrochloride was continuously pumped0.5～1.0ug/kg/min to maintain anesthesia.Minimum alveolar gas concentration(MAC)of inhaled anesthetic drugs in both groups was controlled between 1.0 and 1.6,and BIS was maintained at 45-65.The infusion rate was adjusted according to BIS value and vital signs.Meanwhile,collect baseline preoperative clinical indexes of two groups of children,in the process of operation,observe two groups of children before anesthesia induction(T0),1 min after induction(T1),10 min after induction(T2),30min(T3)after induction,and at the end of surgery(T4),mean arterial pressure,mean arterial pressure,MAP)and heart rate,heart rate,HR),by ria method to detect the adrenaline and noradrenaline,and record time of two groups of postoperative revival.result:There were no significant differences in age,gender,BMI,ASA grade,cleft lip and palate type and operation duration between the two groups.Sp O2 and BIS values at T0,T1,T2,T3 and T4 were not significantly different between group D and group S(P > 0.05);MAP and HR at T0,T1 and T2 were not significantly different between group D and group S(P > 0.05).The difference between MAP and HR at T3 and T4 was statistically significant(P < 0.05),and the changes in group S were more dramatic than those in group D.There were no significant differences in blood glucose,adrenaline and norepinephrine levels between group D and group S at T0,T1 and T2(P > 0.05).Compared with group D,the blood glucose level at T4 in group S was significantly increased,and the adrenaline and norepinephrine levels at T3 and T4 in group S were significantly increased(P < 0.05).Compared with group D,postoperative recovery time and wakefulness time of children in group S were prolonged(P < 0.05),and postoperative Riker sedation and agitation score of children in group S was higher than that in group D(P=0.02).conclusion:Both desflurane and sevoflurane can be used in the operation of cleft lip and palate in children.However,compared with sevoflurane,desflurane can more effectively reduce the stress response,and the hemodynamics is more stable,and the recovery is more complete and rapid,safe and effective,which is worthy of clinical promotion and application.