The Clinical Observation Of Dexmedetomidine Hydrochloride Applied In Patients With Knee Arthroscopic Surgery During Combined Spinal-epidural Anesthesia

The combined spinal-epidural anesthesia has been widely used for anesthesia inthe lower limb surgery, and achieved good clinical effects. But the spinal-epiduralanesthesia only solve the anesthesia field in surgery. With the improvement ofpeople’s living standards, the requirements of anesthesia is also becoming more andmore perfect. So how to eliminate the psychological and spiritual reaction broughtabout by the people during surgery and anesthesia, become the real problems whichthe anesthesia workers must face it.ObjectiveTo explore the effect of hydrochloric acid dexmedetomidine on Ramesay, VSA,plasma cortisol concentration and hemodynamic changes in patients with kneearthroscopic surgery during combined spinal-epidural anesthesia.Materials and MethodsInformed consent of the patients,60patients with grade Ⅰ-Ⅱ undergoingelective arthroscopic surgery (including joint cavity debridement, loose body removalsurgery, meniscus trimming/repair or resection patients, excluding heart, liver,kidney major diseases; drug abuse patients; patients with a history of epilepsy andmental illness; nearly three months to use other drugs patients) was choosen for thisstudy. Each group had20cases, were randomly divided into control group (given0.9%saline), Dex lower dose group (given Dexmedetomidine Hydrochloride0.5ug kg-1h-1), Dex higher dose group (given Dexmedetomidine Hydrochloride1ug kg-1h-1). These drugs were administrated before anesthesia15min and theinfusion time of10min. The L3-4was selected as the combined spinal epiduralanesthesia puncture point.0.5%bupivacaine (10%glucose1ml+bupivacaine2ml)3ml was used as spinal anesthesia, the regional block plane was controlled in T6. Theblood pressure (BP), heart rate (HR), oxygen saturation (SPO2) changes were monitoring at T1(before surgery room), T2(before anesthesia), T3(immediately afteranesthesia), T4(5min after anesthesia), T5(10min after anesthesia), T6(the start ofsurgery), T7(5min after the start of the surgery) and T8(surgery end). The serumcortisol concentrations was measured at three time points (after surgery room, the endof surgery, the24h after surgery). And Ramsay, VAS score was observed andanalgesic drug application and sensory and motor nerve block duration time wasrecorded at24h after surgery.Result1.No significant differences were found among the three groups in age, height,body weight, duration of surgery.(P>0.05).2.Hemodynamic results show that compared with T1time, systolic bloodpressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) ineach group were significantly decreased (P<0.05). Compared with the controlgroup, SBP, DBP, MAP and heart rate (HR) in the Dex low dose group and high dosegroup were also significantly decreased (P <0.05).Compared with Dex small dose, the HR in Dex high-dose group werealso significantly decreased (P <0.05), but there were no difference betweenthese two groups in SBP, DBP,and MAP3. No significant differences were found among the three groups in soxygensaturation at different times (p>0.05). oxygen saturation maintained at more than95%.4The cortisol concentration in patients with the control group graduallyincreased, reached the peak at24h after operation; the cortisol concentration indifferent dose of Dex group were significantly reduced after operation iscompleted. Then the cortisol concentration was increase at24hafter operation,but still significantly lower than that of the control group.5. VAS score was measured at24h after the operation. Compared with thecontrol group, the pain intensity can be significantly alleviate (P <0.05), and theanalgesic effect in Dex high doses group was better than low dose.6Ramsay score was measured at24h after the operation. Compared with the controlgroup, the score in different doses of Dex group was significantly increased. Itsuggested that Dex has a sedation effect on anesthesia patient. Conclusion1.Dex has intraspinal synergistic effect and can enhance the effect ofbupivacaine in spinal anesthesia, prolong the duration of action in the spinal canal, hasobvious sedative, analgesic effect when Dex applied in patients with kneearthroscopic surgery during combined spinal-epidural anesthesia2. Dex can reduce the of cortisol concentration in plasma, thereby reducingthe adverse reactions caused by the stress response;3Dex can stable the Haemodynamic during the perioperative period.