Clinical Study Of Dexmedetomidine Combined With Propofol And With Etomidate For Embolization Of Intracranial Aneurysm

Objective:The purpose was to investigate the feasibilities, advantages anddisadvantages by using micro-infusion pump to inject dexmedetomidinerespectively combined with propofol and with etomidate forembolization of intracranial aneurysms without the use of tracheacannula, to discuss a safer and more effective method of anesthesia forintracranial aneurysms with a quicker analepsia and fewer complication.Method:We divided the120patients who would undergo the ebolization ofitracranial aneurysm into propofol group (P group), dexmedetomidinecombined with propofol group (DP group), and dexmedetomidinecombined with etomidate group (DE group) randomly.Patients in group P were injected fentanyl1.0μg/kg, propofol0.5～1mg/kg for the induction of anesthesia, then injected propofolcontinuously and adjusted propofol to keep BIS ranging from60to70.If the patient could not maintain fixed which could not be coordinatedwith the surgery, injected appropriate amount of propofol. Stoppedinjecting propofol5minutes before the end of the surgery.Patients in group DPwere injected fentanyl1.0μg/kg, propofol0.5～1mg/kg for the induction of anesthesia, then injected dexmedetomidine andpropofolcontinuously. Kept dexmedetomidine0.3μg/（kg·h）and adjustedpropofol to keep BIS ranging from60to70. If the patient could not maintain fixed which could not be coordinated with the surgery, injectedappropriate amount of propofol. Stopped injecting propofol anddexmedetomidine5minutes before the end of the surgery.Patients in group DE were injected fentanyl1.0μg/kg，etomidate0.2～0.4mg/kg for the induction of anesthesia, then injecteddexmedetomidine and etomidate continuously. Kept dexmedetomidine0.3μg/（kg· h） and adjusted etomidate to keep BIS ranging from60to70. If the patient could not maintain fixed which could not becoordinated with the surgery, injected appropriate amount of etomidate.Stopped injecting etomidate and dexmedetomidine5minutes before theend of the surgery.All patients underwent the intracranial aneurysm embolization withlocal anesthesia. During the surgical operation, observed the patients’breath seriously. If the patients breathed unsmoothly, we would place anoropharyngeal airway. When patients’ blood pressure increased ordecreased30%compared with the basic value we would use vasoactivedrug to adjust it back to normal. When patients HR <60t/m we shoulduse atropine0.3mg. When patients’ SpO2≤90%kept10s (respiratorydepression) we should use a face mask to assist their breath.Recorded the patients’ blood, heart rate and blood oxygensaturation at the time they enter the room (T0), the time they were afterinduction (T1), the time started the surgery (T2), the catheter reach theaneurism (T3), the time they awaked (T4). Recorded the time when theyawaked (T5), the time when they could answer questions clearly (6), thecases of the depression of breath, the cases of nausea and vomit within24hours after surgery.Result:1. Comparison of hemodynamics:(1) The blood pressure ofpatients in group P and group DP at T1, T2, T3, T4decreasedsignificantly compared with that at T0, there were significant differences compared with T0time(P<0.05). The blood pressure of patients ingroup ED at T1, T2, T3, T4decreased unclearly compared with that atT0, there were no significant differences compared with T0time(P>0.05).(2) The blood pressure of patients in group P and group DP atT1, T2, T3had significant differences compared with that in groupDE(P<0.05); The blood pressure of patients in group P at T2, T3hadsignificant differences compared with group DP(P<0.05).2. The times when the patients of P group woke up and answeredquestions clearly were (8.10±1.80) min and (17.45±3.21) min. The timeswhen the patients of DP group woke up and answered questions clearlywere (7.70±1.78) min and(17.25±2.65) min. The times when the patientsof DE group woke up and answered questions clearly were (8.55±2.41)min and(18.45±3.08) min. There were no significant differences amongthe three groups(P>0.05).3．The depression of breath: The numbers of cases in group P,group DP and group DE were11,4and0.The difference between Pgroup and DP group, the difference between P group and DE group andthe difference between DP group and DE group all had a statisticallysignificance (P <0.05).4. The number of postoperative nausea and vomiting in P groupwere2,0, DP group were3,0, DE group were9,1. The differencebetween DE group and P group had a statistically significance (P<0.05).The difference between DP group and DE group had a statisticallysignificance (P <0.05). The difference between P group and DP grouphad no statistically significance (P>0.05).Conclusion:Without the use of trachea cannula, the methods of anaesthesia byusing micro-infusion pump to inject dexmedetomidine combined withpropofol and with etomidate for embolization of intracranial aneurysmswere feasibility and safe, better than using propofol alone. Dexmedetomidine combined with propofol had a more stable respirationand circulation; Dexmedetomidine combined with etomidate hada lower incidence rate of postoperative nausea and vomiting.