The Safety And Effectiveness Of Dexmedetomidine Combined With Remifentanil In Painless Gastroscopy

ObjectiveThe purpose of this study is to examine the safety and effectiveness of dexmedetomidine combined with remifentanil in painless gastroscopy and to provide a new comfortable medical solution for gastroscopy.MethodsThis was a double-blind,placebo-controlled study.In-patient patients from November 2019 to January 2022 with the inclusion criteria for painless gastroscopy were eligible for participation.They were randomly and equally divided into dexmedetomidine group Ⅰ,dexmedetomidine group Ⅱ and control group with 40 patients in each group.Dexmedetomidine 0.4μg/kg combined with remifentanil 1μg/kg was used in dexmedetomidine group I,Dexmedetomidine 0.21μg/kg combined with remifentanil 1μg/kg was used in dexmedetomidine group Ⅱ while the control group was treated with fentanyl 1μg/kg combined with propofol 0.5～1.5mg/kg.Systolic blood pressure(SBP),HR,SpO2,End-tidal carbon dioxide partial pressure(PETCO2)were observed and recorded in three groups before anesthesia(T1),after administration(T2),when gastroscope passed throat(T3)and at the end of the examination(T4).Patient’s Ramsay sedation scores,anesthesia time,operation time and any adverse reactions,such as nausea and vomiting,cough,body movement,injection pain,respiratory circulation inhibition were recored.Patients were asked and recorded about their satisfaction,whether to choose the same anesthesia method next time,and abnormal conditions in postoperative follow-up.Results1.There was no statistically significant difference between the three groups in terms of patient age,weight,gender,or ASA grade(P>0.05).2.In terms of Ramsay sedation scores,patients in dexmedetomidine groups Ⅰ andⅡ were awake and sedated,whereas all patients in the control group were asleep and in deep sleep,a statistically significant difference(P0.05).3.The rate of apnea event was considerably reduced in the dexmedetomidine group Ⅰ and dexmedetomidine group Ⅱ compared to the control group(P0.05).There was no statistically significant difference in the incidence of SpO290 percent between the three groups(P>0.05).PETCO2 measurements from dexmedetomidine groups Ⅰand Ⅱ were significantly greater than those from the control group at time points T2 and T3(P0.05).In the case of SpO2,data from the dexmedetomidine group Ⅱ were substantially higher than those from the control group(P0.05).4.In terms of SBP,data from the dexmedetomidine groups Ⅰ and Ⅱ were substantially higher than those from the control group at time points T2,T3,and T4(P0.05).In terms of HR,dexmedetomidine group Ⅰ data were significantly lower than dexmedetomidine group Ⅱ and control group data at time point T2(P0.05).5.The dexmedetomidine group Ⅱ surgery took longer than the control group(P0.05).6.There were no significant differences in adverse reactions such as nausea and vomiting,cough,and HR50 times/min across the three groups(P>0.05).The incidence of body movement was substantially lower in dexmedetomidine group Ⅰthan in dexmedetomidine group Ⅱ(P0.05).Injection discomfort and hypotension are less common in the dexmedetomidine groups Ⅰ and Ⅱ,according to adverse reaction records than control group(P<0.05).7.Patient satisfaction was considerably higher in the dexmedetomidine group Ⅰand control groups than in the dexmedetomidine group Ⅱ(P<0.05).No outstanding differences between the three groups’ whether to choose the same anesthesia method next time and abnormal conditions in postoperative follow-up were noted(P>0.05).ConclusionDexmedetomidine 0.4μg/kg combined with remifentanil 1μg/kg for gastroscopy can keep the patient awake and sedated,in hemodynamic stability,respiratory depression,drug injection pain rate is better than the control group and it was superior to dexmedetomidine group Ⅱ in terms of the incidence of body movement and patient satisfaction.Therefore,dexmedetomidine 0.4μg/kg combined with remifentanil 1μg/kg for gastroscopy with stable hemodynamics,mild respiratory depression and no pain from drug injection,has a definite clinical effect and few adverse reactions,and it is worthy of clinical promotion.