Evaluation Of Anesthesia Effect Of Dexmedetomidine Combined With Etomidate In Elderly Patients Undergoing Bronchoscopy

Objective To explore the anesthetic effect,adverse reactions and hemodynamic changes of elderly patients with intravenous injection of etomidate combined with different doses of dexmedetomidine during fiberoptic bronchoscopy.Methods Random number table method was used to divide 120 elderly patients who planned to undergo painless fiberoptic bronchoscopy into 4 groups.Group D1,Group D2,Group D3 and Group C respectively.ASA gradeⅠ/Ⅱgrade,BMI is16-30kg/m2,the age is over 65 years old,and the gender is not limited.All patients were banned from drinking for 4 hours and fasting for 8 hours according to routine requirements before performing fiberoptic bronchoscopy,and they did not use any preoperative drugs.After entering the operation room of the endoscope,lie in the outpatient examination car and lay high-flow oxygen（6L/min）.Establish a peripheral venous access at the right upper limb of the patient to monitor the patient’s vital signs.10 minutes before the induction of anesthesia,D1 group,D2 group and D3 group were injected with 0.25μg·kg-1·h-1,0.50μg·kg-1·h-1,0.75μg·kg-1·h-1Dexmedetomidine;Group C pumped with equal volume of saline.Afterwards,2%lidocaine was used for surface anesthesia of the nasal mucosa and throat.Intravenously inject 10mg dexamethasone,0.15μg/kg sufentanil,0.15-0.2mg/kg etomidate.After the completion of the injection of all drugs,after the patient’s consciousness disappeared and there was no eyelash reflex,the fiber bronchoscope operation was started（all were checked by the same physician）.If there is severe choking,restlessness,and body movements during the examination that are obviously unable to continue the examination,intravenously add an initial count of 1/4etomidate.Recording after entering the room（T₀）,immediately after induction（T₁）,immediately after the fiberoptic bronchoscope enters the glottis（T₂）,immediately after the fiberoptic bronchoscope reaches the carina（T₃）,immediately after the fiberoptic bronchoscope exits the glottis（T₄）,and the inspection is completed 10min（T₅）MAP,HR,Sp O₂.Count the amount of etomidate used in each group during fiberoptic bronchoscopy,anesthesia recovery and time to leave the room.Observe the occurrence of adverse reactions such as myoclonus,pain from vascular injection,nausea and vomiting,and bradycardia.Result（1）From T₁to T₄,D1 group,D2 group and D3 group had lower MAP than T₀（P<0.05）;compared with C group,D1 group,D2 group and D3 group had lower MAP at T₂（P<0.05）;and Compared with D3 group,MAP increased in D1 group,D2group and C group at T₅（P<0.05）.In group C,at T₂,the HR increased faster than that at T₀（P<0.05）;compared with group C,the HR decreased at T₂in groups D2 and D3（P<0.05）.When D1 group T₁was present,Sp O₂decreased compared with T₀（P<0.05）（2）Compared with D1 group,the amount of etomidate was reduced in D2 and D3 groups（P<0.05）;Group C,D1,D2,D3 There was no statistically significant difference in the recovery time between the groups;compared with group C,the time to leave the room was shortened in groups D1,D2,and D3（P<0.05）（3）Compared with group C,the incidence of myoclonus was reduced in groups D2 and D3（P<0.05）.After that,the myoclonus grading was compared between each group.Compared with group C,the grades of myoclonus in groups D2 and D3 were also lower（P<0.05）（4）compared with group C,nausea in groups D1,D2 and D3 The incidence of vomiting and intravascular pain decreased（P<0.05）.There was no statistically significant difference in the incidence of bradycardia between D1 group,D2 group,D3 group and C group（P>0.05）.Conclusion For elderly patients,painless fiberoptic bronchoscopy,compared with intravenous etomidate,combined with 0.5μg·kg-1·h-1 dexmedetomidine continuous pump injection,hemodynamics is stable,reducing the dependence Imidate dosage and the incidence of adverse reactions are further reduced,and the anesthesia effect is better.It is a feasible outpatient anesthesia application program.