Study On Sedative And Analgesic Effects Of Intranasal Different Dose Of Dexmedetomidine In Children Undergoing General Anesthesia In Oral Clinic

Objective:To observe the sedative and analgesic effects of intranasal different doses of dexmedetomidine in oral clinic undergoing general anesthesia,and to explore the effects of different doses of dexmedetomidine on intraoperative hemodynamics and emergence agitation during recovery.Methods:Eighty children were enrolled in the oral clinic who planned to receive oral treatment under general anesthesia.They were ASA grade Ⅰ,aged 4～6 years,and had no symptoms of upper respiratory tract infection within 2 weeks.The patients were divided into four groups by random number table method,control group（group C）,1.0μg/kg intranasal dexmedetomidine group（group D1）,1.5μg/kg intranasal dexmedetomidine group（group D2）and 2.0μg/kg intranasal dexmedetomidine group（group D3）,with 20 children in each group.Children were visited 1 day before operation（T₀）and their basic information and hemodynamic indicators（SBP,HR,RR,SpO₂）were recorded.In the preoperative preparation room,accompanied by their family members,children in the four groups were instilled 0.5 ml through bilateral nostrils,dexmedetomidine 1.0μg/kg（D1 group）,1.5μg/kg（D2 group）,2.0μg/kg（D3 group）and the same volume of normal saline（0.5 ml）（C group）.After 30 min later,the patient was induced by 8%sevoflurane then a laryngeal mask was inserted,and 3%to 5%sevoflurane was inhaled during the operation to maintain anesthesia.At the end of the operation,sputum suction was performed,and the laryngeal mask was pulled out after the child met the extubation conditions.After observation for 10 minutes,the patient was sent to the post-anesthesia care unit（PACU）.After observation for at least 1 hour in PACU,the patient was discharged from the hospital once the Aldrete score was 9 or above.Systolic blood pressure（SBP）,heart rate（HR）,respiratory rate（RR）and pulse oxygen saturation（SpO₂）of the four groups were observed and recorded at seven time points before surgery（T₀）,10 min（T₁）,20 min（T₂）,30 min（T₃）,immediately after laryngeal mask insertion（T₄）,immediately after laryngeal mask removal（T₅）and 30 min after surgery（T₆）.Observe and record the parental separation emotion score when entering the room and the mask acceptance score during induction.Ramsay sedation score of T_2-4before operation was observed and recorded.The extubation time,eye opening time and anesthesia time of the four groups were recorded.The PAED agitation score and the number of cases of agitation were observed and recorded during the recovery period.The modified Children’s Hospital of Eastern Ontario Pain Score（mCHEOPS score）was followed up and recorded 2 hours and 4 hours after operation.Results:1.The general conditions of children in each group:There was no significant difference in age,gender,weight,and operation time among all groups（P>0.05）.2.Comparison of preoperative sedation effects:the preoperative Ramsay sedation score of dexmedetomidine group（D2 and D3 group）was higher than that of the C group（P<0.05）,indicating obvious sedation effect,lower parental separation emotion score,and higher mask acceptance score.3.Comparison of postoperative analgesic effects:Compared with group C,the pain scores of children in the dexmedetomidine group（D1,D2 and D3 groups）at 2 and 4 h after surgery were significantly lower,with both statistically significant（P<0.05）.4.Comparison of agitation during recovery period:Compared with group C,the postoperative PAED agitation score of dexmedetomidine group（D2 and D3 group）was lower,the difference was statistically significant（P<0.05）,the proportion of postoperative agitation was lower（P<0.05）.5.Comparison of vital signs:Compared with group C,SBP in group D3 was decreased at time points of T₃-T₆,all of which were statistically significant.Compared with group C,there was no significant difference in SBP in groups D1 and D2 at T₁-T₆（P>0.05）.Compared with group C,HR in groups D1,D2 and D3 was decreased at T₃-T₆ time points（P<0.05）.Compared with group C,HR in groups D1,D2 and D3 was decreased at time points of T₄-T₆（P<0.05）.Compared with C group,SpO₂in both D2 and D3 groups was decreased at time points of T₃ and T₆（P<0.05）.Conclusions:The results of our study demonstrate that administering 1.5μg/kg-2.0μg/kg of dexmedetomidine via intranasal drops provides effective preoperative sedation,notable postoperative analgesia,and a significant reduction in postoperative PAED agitation scores.Thus,this dosage and administration method can be recommended for sedation prior to general anesthesia in pediatric patients.