Effects Of Different Sedatives On Perioperative Anxiety And Sleep Quality In Patients Undergoing Modified Radical Mastectomy

BackgroundPostoperative sleep disturbance（POSD）,as a common postoperative complication,has a serious negative impact on the physical and mental health of patients.According to statistics,the prevalence of postoperative sleep disorders worldwide is about 10%to 70%,and different types of surgery,anesthesia schemes,age,gender,etc.are all influencing factors.In contrast,breast cancer surgery is more likely to cause postoperative sleep disturbance.How to alleviate postoperative sleep disturbance and promote patient recovery has become one of the hot issues in the field of anesthesia in recent years.Anesthetic drugs can affect postoperative sleep quality by changing biological rhythms and regulating hormone levels.Different types of anesthetic drugs are closely related to POSD,and have different effects on postoperative sleep.Remimazolam,propofol and etomidate are three commonly used intravenous anesthetics in the clinical field at present.They have been widely used in general anesthesia induction and maintenance,ICU sedation,painless diagnosis and treatment,etc.,and have been approved by most anesthesiologists.recognition.However,the effects of these three anesthetic drugs on postoperative sleep quality are still controversial,and there are currently no studies that directly compare their effects on postoperative sleep.In the case of remimazolam,some studies suggest that it may cause a decrease in postoperative sleep quality,but others suggest that it has a lesser effect on sleep;propofol may have a lesser effect on total postoperative sleep duration,but may Affect the proportion of deep sleep;etomidate may affect the sleep structure and reduce the continuity of sleep.These studies have their rationale,but further studies are needed to confirm them.Therefore,this study aims to investigate the effects of three anesthetic drugs,remimazolam,propofol and etomidate,on sleep quality after breast cancer surgery,in order to provide relevant clinical reference.ObjectiveThis study explored the effects of three sedatives,remimazolam,propofol and etomidate,on perioperative anxiety and sleep quality in patients undergoing modified radical mastectomy for breast cancer.Materials and MethodsA total of 91 patients who underwent modified radical mastectomy for breast cancer in the Breast and Thyroid Surgery Department of the First Affiliated Hospital of Henan University from April 2022 to November 2022 were selected,and they were divided into 3 groups by random number table method.Remimazolam tosylate group（R group）30 cases,propofol group（P group）31 cases and etomidate group（E group）30 cases.After entering the operating room and connected to monitoring,15ml of 0.33%ropivacaine was used at T₃-₄ level to perform thoracic paravertebral nerve block,and anesthesia induction was performed after the block was successful.Anesthesia induction:Group R received intravenous injection of remimazolam0.15-0.35 mg/kg,group P received intravenous injection of propofol 1.0-3.0 mg/kg,group E received intravenous injection of etomidate 0.1-0.5 mg/kg,all three groups received intravenous injection Sufentanil0.3-0.5μg/kg and rocuronium bromide 0.6 mg/kg were injected.Anesthesia maintenance:all three groups were given total intravenous anesthesia,group R received remimazolam 0.5-1.0 mg/kg/h by pump,group P received propofol 4-12 mg/kg/h by pump,group E Etomidate was pumped at 0.3-1.2 mg/kg/h,the three groups were continuously pumped with sufentanil at 0.2-0.6μg/kg/h,and 0.1 mg/kg of rocuronium bromide was intermittently injected to maintain blood pressure fluctuations at Within 20%of the baseline value,the BIS changes between 50 and 60.The patients were followed up from 7:30 to 9:30 am on the day before operation and the day of operation,and on day 1,2,3,5,and 7 after operation.One day before operation,the Pittsburgh Sleep Quality Index（PSQI）scale and the Hamilton Anxiety Scale（HAMA）were used to evaluate the baseline sleep and emotional status of the patients;the Athens Insomnia Scale（Athens Insomnia Scale,AIS）to evaluate the subjective sleep status of patients on the first day before operation and on the first,third,fifth,and seventh days after operation;wearable devices（Huawei 7 wristband）were used to record sleep on the first night before operation and the first,second,and third nights after operation Objective data of status;record before induction of general anesthesia（T₀）,after induction of anesthesia（T₁）,immediately after laryngeal mask placement（T₂）,at the time of skin incision（T₃）,at the end of the operation（T₄）,and when the laryngeal mask was pulled out（T₅）The average blood pressure（MBP）and heart rate（HR）at each time point;4h,24h,48h,and 72h after surgery were used to evaluate the patient’s pain using the Numerical Rating Scale（NRS）;the operation time,anesthesia time,drug withdrawal to pull out were recorded.The time of leaving the laryngeal mask,the Ramsay sedation score 1 hour after the operation,and the occurrence of respiratory depression,injection pain,muscle tremor,bradycardia,nausea and vomiting,and intraoperative awareness were recorded.Result（1）General information:A total of 91 surgical patients were included in this study,including 30 cases in the remimazolam group,31 cases in the propofol group,and 30 cases in the etomidate group.The age,BMI index,ASA anesthesia grade,and PSQI sleep index and other general data were not statistically significant（P>0.05）.（2）Anxiety:Compared with the 1 day before operation,the HAMA scale scores of the three groups were significantly reduced on the 1st,3rd,5th,and 7th day after the operation,and the difference was statistically significant（P<0.05）.（3）In terms of sleep quality:Compared with the 1 day before operation,the AIS scores of the patients in the three groups increased on the 1st,3rd,and 5th days after the operation,and the differences were statistically significant（P<0.05）.The score was higher than that of group P and group E,and the difference was statistically significant（P<0.05）.The Huawei 7 wristband shows that on the first night after surgery,the proportion of deep sleep in group R was significantly lower than that in groups P and E,the difference was statistically significant（P<0.05）,and the proportion of light sleep in group P was significantly lower The difference was statistically significant in group R and group E（P<0.05）;also on the first night after surgery,the proportion of rapid eye movement sleep among the three groups was significantly different,the proportion of group P>the proportion of group R>E There were statistically significant differences between the two groups（P<0.05）.Compared with the night before operation,the proportion of rapid eye movement sleep was significantly lower in the first and second nights after the operation in the R and P groups,and the difference was statistically significant（P<0.05）;In comparison,the proportion of rapid eye movement sleep decreased more significantly on the first night after surgery,and the difference was statistically significant（P<0.05）;however,on the second night after surgery,the proportion of rapid eye movement sleep in group E rebounded significantly,reaching the level of the night before operation,which was significantly higher than that of group R and group P,and the difference was statistically significant（P<0.05）.（4）Analgesia:There was no significant difference in NRS pain scores at each time point after operation among the three groups（P>0.05）.Compared with postoperative 72h,the NRS pain scores of the three groups were higher at 4h,24h,and 48h postoperatively,and the difference was statistically significant（P<0.05）.（5）Hemodynamics:At T₁,T₃,and T₄,the MBP of group P was significantly lower than that of group R and group E,and the difference was statistically significant（P<0.05）.In group P,at T₁,T₃,T₄,MBP was significantly lower than T₀,and the difference was statistically significant（P<0.05）;in addition,when P was at T₁,HR was significantly lower than T₀,the difference was statistically significant（P<0.05）.There was no significant difference in MBP and HR between R and P groups at each time point（P>0.05）.（6）In terms of postoperative recovery:the postoperative time of pulling out the laryngeal mask in group R was longer than that in groups P and E,and the difference was statistically significant（P<0.05）;there was no statistically significant difference in Ramsay sedation score 1h after operation among the three groups（P>0.05）.（7）In terms of adverse reactions:During the perioperative application period,17 patients in group P experienced injection pain,with an incidence rate of about 55%,which was significantly higher than that in groups R and E,and the difference was statistically significant（P<0.05）;There was no significant difference in the incidences of respiratory depression,muscle tremor,bradycardia,and nausea and vomiting among the three groups（P>0.05）,and there was no intraoperative awareness in the three groups.Conclusion1.Postoperative anxiety states of patients in the three groups of remazolam,propofol and etomidate were improved,but there was no significant difference in the degree of improvement between the three.2.Remimazolam,propofol,etomidate,three sedative hypnotics all reduced the sleep quality on the 1st,3rd,and 5th day after operation,and changed the sleep structure on the 1st and 2nd night after operation.3.Propofol has little effect on postoperative sleep structure and sleep quality,but has a relatively large effect on intraoperative hemodynamics;remimazolam has a significant effect on postoperative deep sleep,etomidate has a significant effect on rapid eye movement Sleep has a greater impact,but both intraoperative hemodynamics are relatively stable.