The Clinical Effect Of Dexmedetomidine Combined With Alfentanil In Elderly Patients Undergoing ERCP Surgery And The Effect On Stress Response

Objective:The purpose of this study was to explore the anesthetic effect and safety of dexmedetomidine combined with alfentanil for ERCP in elderly patients,in order to provide a better method of anesthetic drug compatibility for clinical work.Methods:Eighty American Society of Anesthesiologists（ASA）Class I and II elderly patients,aged 60 to 90 years old,who underwent ERCP surgery from January 2022 to January2023 in our hospital were selected,approved by the hospital ethics committee,and all patients in the study signed an informed consent form.The patients were divided into two groups with 40 cases in each group by random number table method.Group A was given 5μg/kg Alfentanil intravenously slowly for more than 30 seconds,followed by continuous pump injection of dexmedetomidine 1μg/kg for 10min.The sedation level of patients was scored using the Ramsay sedation scale（RSS）.Diagnostic and therapeutic procedures were initiated when the patient was moderately sedated,unresponsive or non-responsive to injurious stimuli.Anesthesia was maintained with continuous pump injection of dexmedetomidine（1～2μg/kg/h）and alfentanil（0.5μg/kg/min）until the end of the examination.Group F was given 2μg/kg fentanil intravenously slowly for more than 30 seconds,followed by continuous pump injection of dexmedetomidine 1μg/kg for 10min.The patient’s Ramsay score was assessed,and diagnostic and therapeutic procedures were initiated when the patient was moderately sedated,unresponsive or non-responsive to injurious stimuli.Anesthesia was maintained with continuous pump injection of dexmedetomidine（1～2μg/kg/h）and fentanil（0.01μg/kg/min）until the end of the examination.After the operation,the patient was sent to the anesthesia resuscitation room for observation of various indicators.The age,gender,height,weight and ASA grades of the two groups were recorded;the mean arterial pressure（MAP）,heart rate（HR）and pulse oximetry saturation（Sp O₂）were recorded in both groups before anesthesia（T0）,after induction of anesthesia（T1）,endoscopy through the throat（T2）,10 min after the start of surgery（T3）,and at the end of surgery（T4）;the onset time of anesthesia,operation time,recovery time;cortisol hormone levels before anesthesia（T0）,endoscopy through the throat（T2）and at the end of surgery（T4）in both groups;the dosages of dexmedetomidine and vasoactive drugs were recorded;adverse reactions such as nausea and vomiting,respiratory depression and bradycardia were recorded during perioperative period.Results:1.There was no statistically significant difference between the two groups in terms of age,gender,height,weight and ASA grades（P>0.05）.2.Comparison of mean arterial pressure:Compared with T0,the mean arterial pressure in the two groups at T1,T2,T3 and T4 was decreased（P<0.05）,and there was no statistically significant difference in the mean arterial pressure at each time point between the two groups（P>0.05）.3.Comparison of heart rate:Compared with T0,the heart rate of patients in both groups were lower at moments T1,T2,T3,and T4（P<0.05）,and there was no statistical significance in the heart rate at each time point between the two groups（P>0.05）.4.Comparison of pulse oximetry saturation:there was no difference at each time point（P>0.05）.5.Comparison of serum Cor levels:there was no difference at each time point（P>0.05）.6.The onset time of anesthesia and recovery time of group A were shorter than those of group F,and the difference was statistically significant（P<0.05）,but there was no statistically significant difference in operation time between the two groups（P>0.05）.Intraoperative dexmedetomidine dosage,ephedrine dosage,and atropine dosage were compared,and the differences were not statistically significant（P>0.05）.7.No excessive sedation occurred in the two groups,and the rate of adverse anesthetic reactions in group A was lower than that in group F,the difference was statistically significant（P<0.05）.Conclusion:1.The combination of dexmedetomidine and alfentanil for ERCP anesthesia in elderly patients can achieve similar anesthetic effects as the combination of dexmedetomidine and fentanyl.It can not only maintain hemodynamic stability,but also reduce stress response,and has little impact on respiratory function,so it can be used as one of the sedative and analgesic programs of ERCP.2.Compared with dexmedetomidine combined with fentanyl,dexmedetomidine combined with alfentanil can accelerate the onset time of anesthesia and shorten the recovery time,reduce the incidence of adverse reactions,and improve perioperative safety,especially for elderly patients.