Effect Of Different Maintenance Doses Of Dexmedetomidine Combined With Remifentanil On Transbronchial Tracheal Intubation Guided By Fiberoptic Bronchoscopy

Objective:Comparison of different maintenance doses of dexmedetomidine combined with remifentanil for bronchoscopy guided nasal awake tracheal intubation.Methods:Sixty patients who underwent elective general anesthesia and were expected to have a difficult airway were randomly divided into 3 groups(n=20): C,D1,and D2 groups.Three groups of patients were given a loading dose of DEX1.0 ug·kg-1 for 15 min,and remifentanil 0.1 ug·kg-1·min-1 was continuously pumped.After the loading dose of DEE infusion was completed,patients in group C were given saline pumping as control group,D1 group was given DEX0.5 ug·kg-1·h-1,and D2 group was 1.0 ug·kg-1·h.-1maintenance.After the end of the DEX load-dose pumping,the three groups were guided by the bronchoscope to guide the nasal awake tracheal intubation.Monitoring hemodynamics at different time periods(recording before anesthesia(T0),immediately before intubation(T1),intubation is completed immediately(T2),5 min after intubation(T3),changes in SBP,DBP,HR To observe the tolerance score during intubation and after intubation,record the success time of intubation,adverse reactions during intubation,intubation satisfaction scores of patients 24 hours after surgery,and memory scores of postoperative patients during intubation.Results:Compared with T0 group,SBP,DBP and HR were significantly decreased in T1group(P<0.05).SBP,DBP and HR in group C and T3 were significantly higher than T0 and higher than D1 and D2(P<0.05).In the D1 and D2 groups,the heart rate increased but not significant,compared with T0(P>0.05)compared with C group(P<0.05);D2 group T1,T3 heart rate was significantly lower than C,D1 group(P <0.05).Compared with group C,the D1 and D2 patients had a statistically significant difference in intubation tolerance score,post-intubation tolerance score,postoperative satisfaction score,and intubation success time(P<0.05),but D1.There was no significant difference between the two groups(P>0.05).There were statistically significant differences in the memory scores of the intubation between the three groups in the D2,D1,and C groups(P<0.05),and the D2 group had bradycardia.The incidence of adverse reactions such as hypoxemia was higher than that of D1 and C(P<0.05).Conclusion:On the basis of topical anesthesia,a dose of 0.5 ug·kg-1·h-1 maintenance dose combined with low-dose remifentanil can be safely and effectively used for fiberoptic bronchoscopy guided nasal awake tracheal intubation,which can provide better Hemodynamic stability,improve patient intubation tolerance,reduce patient intubation memory,shorten intubation success time,improve postoperative patient satisfaction,and reduce the incidence of adverse reactions.