Application Of Propofol Combined With Dexmedetomidine In Awake Anesthesia Under Narcotrend Monitoring

ObjectiveTo discuss the feasibility of dexmedetomidine and laryngeal mask airway in awaken craniotomy. Comparing the advantages and disadvantages between propofol combined with dexmedetomidine for asleep-awake anaesthesia during the Narcotrend monitoring, in order to provide more choices for selecting anaesthesia methods of awaken craniotomy.Methods1Sixty patients undergoing:Group A:proporol+dexmedetomidine (0.2u g. kg-1·h-1).Group B:proporol+dexmedetomidine (0.4μg. kg-1·h-1). Group C:proporol+dexmedetomidine (0.6μg. kg-1·h-1),20each. After induce, intravenous pumping dexmedetomidine (an initial dose of0.4μ g/kg for10min, followed by a continuous infusion of0.2μ g. kg-1·h-1or0.4u g. kg-1·h-1or0.6u g. kg-1·h-1). Patients were anaesthetized by proporol+fentanil, the laryngeal mask was used for mechanical ventilation.Stop intravenous pumping proporol under incision infiltration anesthesia and cerebral dura mater topical anesthesia to keep the patient’s awake during brain mapping and tumor resection. Changes of hemodynamics, awakening time and awaking quality under the Narcotrend monitoring were compared between the three groups. The degrees of sedation and analgesia were evaluated through assessment of alertness and sedation scores (OAA/S) and visual analog scale scores (VAS). The relation complication during awaken craniotomy main to including pain, hypertension, tachycardia, airway problems, seizures or convulsion, nausea and vomiting, brain swelling, complaint the urine, air embolism, et al.240cases in the post-anesthesia care unit. ASA physical status I and II. Patients undergoing elective supratentorial mass lesion surgery who were randomly divided into two groups. GroupA:Dexmedetomidine (an initial dose of0.8μg/kg for10min, followed by a continuous infusion of0.6μg/kg/h). GroupB:placebo saline was administered. MAP、HR、SPO2、RR、Ramesay assessment of sedation and adverse reaction were recored.Results1HR in Group C were significantly lower than Group A and B (p<0.05). During awake period, HR and MAP between the three groups were no statistical differences(p>0.05). All patients can be aroused in a short time, however, Group C were longer than Group A and B (p>0.05). The OAA/S in Group C were lower than Group A and B (p<0.05).2The hemodynamic status of Group A was more influenced. Adverse reaction was significantly lesser in GroupA. The experimental group at different time points on blood pressure, heart rate were lower than the control group, Obvious difference in the two groups (P<0.05)Conclusion1Propofol combined with dexmedetomidine and LMA can be well applied for awake surgery, dexmedetomidine (0.4μg. kg-1·h-1) can hold stable hemodynamics and shorter awakening time. Dexmedetomidine (0.4μg. kg-1· h-1) is quite suitable for awake anesthesia.2Dexmedetomidine (an initial dose of0.8μg/kg for10min, followed by a continuous infusion of0.6μg/kg/h) has good sedative for the patients undergoing supratentorial mass lesion postoperation.