Clinical Study Of Sedative Efficacy And Wakefulness Of Dexmedetomidine In Patients With Parkinson’s Disease

Objective:To investigate the effect of Parkinson’s disease on the sedative efficacy and wakefulness of dexmedetomidine.Methods:We recruited neurosurgical patients with non-intracranial space occupying lesions who planned to undergo neurosurgery in the Department of Neurosurgery,Provincial Hospital Affiliated to Anhui Medical University from March 2022 to June2022.All patients with a physical status of II-III according to the American Society of Anesthesiologists,all patients were 45 to 65 years old,BMI ranges from 18.5 to 30.0.No slow arrhythmia,severe hypertension,cognitive or mental disorders,no abnormal liver or kidney function.Patients were divided into control group（group C）and Parkinson’s group（group P）according to whether they had Parkinson’s disease or not.Frailtiness Score Scale and Pittsburgh Sleep Quality Index Scale（PSQI）were used to assess frailtiness and sleep disorders in the last month in all enrolled patients 1 day before surgery.Electrocardiogram（ECG）,pulse oxygen saturation（Sp O₂）,and BIS（1,2,4 leads were attached to the central parietal region and 3 lead was attached to the mastoid process）were performed routinely after entry.Radial artery puncture catheter（20G）was placed for continuous monitoring of blood pressure and blood gas analysis,oxygen inhalation（oxygen flow rate 2L/min）and venous access was opened.The sequential method was used,the initial dose of dexmedetomidine（Yangtze Rlver,Pharmaceutical Co,Ltd.,Jiangsu,China）was 0.5μg/kg,the intravenous infusion time was 10 min,and the patients were observed for another 10 min after the infusion to observe whether they fell asleep.If there are vertex sharp waves or sleep spindles in the EEG,the dose of dexmedetomidine for the next patient was decreased by 0.05μg/kg.In contrast,if there are no vertex sharp waves or sleep spindles in the EEG,the dose of dexmedetomidine for the next patient was increased by 0.05μg/kg.The study was continued until 7“no response/response”crossover pairs had occurred.The wakefulness test was performed on sleeping patients to observe whether they were easy to wake up.Hypertension,hypotension,bradycardia,respiratory depression,nausea and vomiting adverse reactions were recorded.Results:There was no statistically significant difference in general information,including ASA classification,age,sex,BMI,hypertension,diabetes and degree of education between the two groups（P>0.05）.There was no significant difference in the incidence of frailty before surgery between the two groups（P>0.05）.Compared with group C,the incidence of sleep disorders in group P was significantly increased（P<0.05）.The ED50 of patients’sleep induced by dexmedetomidine in group P was0.55μg/kg,while in group C was 0.42μg/kg.Compared with group C,ED50 of patients’sleep induced by dexmedetomidine in group P was increased,and the difference was statistically significant（P<0.05）.Both groups were easy to wake up after sleeping.The incidence of adverse reaction such as hypotensive,hypertension,bradycardia,respiratory depression,nausea and vomiting were not statistically significant in the two groups（P<0.05）.Conclusion:Parkinson’s disease factor reduced the sedative effect of dexmedetomidine,but arousal properties were not affected.