The Effect Of Dexmedetomidine Combined With Bupivacaine Caudal Block On The Prevention Of Agitation In Sevoflurane Children

Objective: To investigate the effect of dexmedetomidine combined with bupivacaine caudal block on the prevention of agitation in sevoflurane children.Methods: Experimental study focused on pediatric hernia,hydrocele,hypospadias,and cryptorchidism.Dexmedetomidine(1.5 ?g/kg)combined bupivacaine caudal was more effective than bupivacaine alone.Tube block can effectively reduce the incidence of agitation after sevoflurane anesthesia in children.A randomized,double-blind trial was conducted and 60 cases of children with cryptorchidism underwent elective surgery for fistula,hydrocele,hypospadias,and cryptorchidism.All children were ASA 1 grade,aged 2-6 years and weighing <25 kg.For this type of surgery,fistula anaesthesia is routinely used to provide intraoperative and intraoperative postoperative analgesia.All patients met the inclusion criteria and excluded criteria: 1.Parental refusal 2.History of bleeding tendency 3.Known to be allergic to the drug involved in the study 4.Blocked site infection 5.Nerve or spinal cord disease 5.Possible mental or developmental delay It will affect the evaluation of postoperative irritability and the children are randomly divided into two groups.In the observation group(BD group)(n=30),0.25% bupivacaine and 1.5 ?g/kg dexmedetomidine were administered,and in the control group(group B)(n=30),only 0.25% bupivacaine was used.The total volume of fistulas in the group was 1 ml/kg.All medications used in the study were prepared by specialized anesthesia nurses.Anesthesiologists,surgeons,PACU nurses,and parents of children were unaware of group status.Each patient was monitored for HR,MAP,Sp O2,end-tidal CO2,and Bispectral Index(BIS).After the baseline values were recorded,100% oxygen and 8% sevoflurane were administered through the mask to induce anesthesia,and then the mask was placed.Anesthesia maintains the use of sevoflurane and 50% oxygen.Adjust sevoflurane concentrations to maintain BIS values between 45 and 55.Peripheral venous access was established with a 22-G trocar,and 5% glucose was infused at a rate of about 5 to 10 ml/kg/hr.Then the caudal was blocked and the child was placed in the left lateral position.Using the 22 G needle,the resistance disappearance method was used to confirm that the puncture was in place.After the blood and cerebrospinal fluid were drawn back,the drug was injected.Then change to supine position.At the beginning of the surgery,there was no body reaction and no increase in HR and MBP over 20% of the baseline value was observed when the skin was incised.This was considered to be a sign of successful fistula block.For research purposes,monitoring values were recorded prior to fistula anaesthesia and recorded every 10 minutes until the end of the procedure.In order to maintain the target BIS value,additional total fentanyl and intraoperativ e and end-tidal expiration sevoflurane concentrations were recorded.After the operation,the child entered the resuscitation room and recorded the resuscitation.The throat mask was removed and the PACU nurse who had trained the irritability score and pai n score was used to score.If the increase in MBP or HR above the baseline value of 20% during surgery is considered to be insufficiently analgesic,intravenous fentanyl 1 ?g/kg need to be administered.Reduction of intraoperative MBP or HR by more than 20 % of the baseline value was defined as hypotension or bradycardia.Hypotension was treated with 10 ml/kg saline solution,10 ml/kg physiological saline was repeated and sevoflurane concentration was reduced if necessary.If hypotension is caused by bradyca rdia,first give atropine 10?g/kg,if the effect is not good,then increase the liquid treatment.After severe postoperative agitation,propofol was given 0.5-1 mg/kg intravenously,and a good respiratory cycle was observed to find the cause of restlessnes s.If the pain is severe,give fentanyl 0.5-1ug/kg intravenously.Aspirator is prepared before surgery to prevent the occurrence of aspiration.Measurements: Before induction of anesthesia,before fistula blockage,fistula blockage was recorded every 10 minutes,heart rate,mean arterial pressure,peripheral oxygen saturation,end-tidal carbon dioxide concentration,exhaled breath sevoflurane concentration,BIS Values,as well as wake-up time,time to remove the mask,PACU time.The time and number of additional sedation analgesics needed during and after surgery were recorded.Is there any nausea,vomiting,exercise weakness,urinary retention,etc.after surgery?Results:1.There was no statistically significant difference in the age,weight,operation ti me and type of surgery between the two groups(P>0.05).2.There was no significant difference in HR,MAP,SPO2,and ETCO2 between the two groups during t1 to t6(P>0.05).3.There was a significant difference in the corresponding values of the end-tidal sevoflurane concentrations between the two groups(P<0.05)4.The scores of facial pain and FLACC between the B-D group and the B group were statistically significant(P<0.05),and the corresponding values of the PAED score were statistically significant(P<0.05).5.There was no significant difference in the time of awake,extubate between the two groups(P>0.05).6.There was no significant increase in bradycardia,hypotension in the B-D and B groups.Conclusion: The combination of dexmedetomidine(1.5 ?g/kg)and bupivacaine sacral can effectively reduce the occurrence of restlessness in sevoflurane children during anesthesia recovery,and the time of anesthesia recovery is not affected,and bradycardia and hypotension are not increased.Occurrence of complications.