Dexmedetomidine Combined With Parecoxib Sodium In Prevention Of The Adverse Reactions In Children During Recovery Period Of General Anesthesia

Objective:To study the effect of dexmedetomidine nasal plus parecoxib sodium in the prevention of adverse reactions in children after tonsillectomy.Methods:From May 2017 to August 2018,60 cases of tonsillectomy and adenoidectomy were selected from the First Hospital of Shanxi Medical University.ASA I-II,35 male children and 25 female children aged 4-11 years,weighing 14-38 kg.There was no history of aspirin allergy,gastrointestinal ulcer,severe blood disease and bleeding tendency,and no recent history of sedative and analgesic drugs.According to the random number table,60 children were divided into combined group,Youmei nasal drops group and saline group,20 cases in each group.Sixty children were fasting for 6 hours before operation and did not drink water for 2 hours.Preoperative intravenous administration of 0.02 mg of Long Tonin and inhalation of 100% oxygen(6 liters per minute)through a mask were performed.30 minutes before the induction of anesthesia,the combined group was intranasally dripped with dexmedetomidine(Jiangsu Enhua Pharmaceutical Co.,Ltd.,batch number: 180312BP)1ug/kg,Volume 1ml,intravenous injection of parecoxib sodium(trademark:Tenet,produced by Pfizer,batch number: H2538)0.75 mg/kg 10 minutes before the induction of anesthesia.30 minutes before anesthesia induction,dexmedetomidine was dripped into nasal cavity for1ug/kg(volume matching 1ml)and kneaded until completely absorbed in dexmedetomidine group.The saline group received intravenous injection of 0.9% of the same volume through a three-way syringe,while the saline group received intranasal drip of 0.9% sodium chloride 30 minutes before induction of anesthesia.Then fentanyl citrate(Yichang)3 mg/kg,propofol injection(diprivan)2 mg/kg and cisatracurium besylate(Xian Ju)0.15 mg/kg were injected intravenously.After reaching a sufficient depth,the oraltracheal tube is sent into the airway,and then the anesthetic is injected into the computer-controlled mode for mechanical ventilation.The tidal volume is set at 5-8 ml/kg,RR13-15 min-1 and PETCO 35-40.Sevoflurane maintained anesthesia(target bis maintained at 40-50)and was stopped 5 minutes before operation.Cardiac beating,mean arterial pressure,oxygen saturation,T0(entering the operating room),T1(extubation time),5 minutes(T2),15 minutes(T3),30 minutes(T4)and 1 hour(T5)were recorded.Awakening observation: Awakening agitation score(PAED),improved pain score(M-Cheops)and adverse events such as nausea,vomiting,hypoxemia and respiratory depression at Eastern Ontario Children's Hospital,Canada.After the operation,the tube was put into the anesthesia recovery room.Respiratory assistant device,suction of sputum and extraction of tracheal tube?Results:There was no significant difference in MAP,HR and T0 among the three groups(P >0.05),but other time points in saline group were significantly higher than that in dextro-American group and combination group,and that in dextro-American group was significantly higher than that in combination group(P < 0.05).The PAED score of T2-T4 saline group was higher than that of combined group and right American group,and that of right American group was higher than that of combined group(P < 0.05).At T2-T5 time point,Ramsay score in saline group was lower than that in combined group and dextro-American group(P < 0.05).The m-CHEOPS score of T2-T5 time point in saline group was higher than that in combination group and right America group,and that in single right America group was higher than that in combination group,with statistical significance(P < 0.05).Respiratory recovery time,awakening time and extubation time did not show significant difference among the three groups(P > 0.05).The incidence of cough in saline group was significantly higher than that in combination group and single dexamethasone nasal drops group(P< 0.05).The incidence of restlessness in saline group was significantly higher than that in combination group,and that in single dextro nasal drops group was significantly higher than that in combination group(P < 0.05).Conclusion:Preemptive analgesia with dexmedetomidine 1 ug/kg nasal drops combined withparecoxib sodium 0.75 mg/kg before induction of pediatric anesthesia can achieve good sedative effect,safe and effective analgesic effect,and significantly reduce the occurrence of adverse reactions in convalescent period.