Influence Of Different Doses Of Dexmedetomidine On The Anesthesia Effect Of Propofol-Fentanyl Combined In Cervical Conization

OBJECTIVECervicalconization is a common gynecological operation.Since the cervical nerve innervation in women belongs to the visceral nervous system,it is insensitive to pain.The anesthetic focus is on inhibitiug the discomfort caused by cervical traction.Although endotracheal intubation general anesthesia is able to complete the procedure,due to the short operation time and small stimulation,excessive sedation is easy to lead to long postoperative recovery time.Dexmedetomidine is able to produce effective sedative and analgesic effects,while synergistic effect with general anesthesia drugs,with a unique slight advantage of respiratory depression.Combined use of dexmedetomide can reduce the amount of sedative and analgesic drugs,it has reduced the impact of such drugs on the patient’s respiratory and circulatory system.Clinical application of dexmedetomidine in a wide rauge of doses,so this study compared the combined different dose of dexmedetomidineon respiration,circulation and recovery time duriug anesthesia in patients undergoiug cervical conization.METHODS Ninety patients,ASA physical status I～II,aged 18～60 years,weighiug 45～75kg,BMI 18～28 kg·m^-2,undergoiug cervical conization,were randomly divided into groups 0.3μg·kg^-1（D1）,0.6μg·kg^-1（D2）,0.9μg·kg^-1（D3）usiug a random number table.Dexmedetomidine 0.3,0.6,0.9μg·kg^-1were infused intravenously for 10 min after the patients entered the room in groups D1,D2,D3respectively.And then TCI propofol(the target plasma concentration was set at 1.5μg·m L^-1)and fentanyl 0.5μg·kg^-1were given.Observation of 5 minutes of inception（T0）,after pumpiug of dexmedetomidine（T1）,start of surgery（T2）,intraoperative 10 minutes（T3）,intraoperative 20 minutes（T4）,completion of surgery（T5）,opening of the eyes（T6）,out of the room（T7）heart rate（HR）,mean arterial pressure（MAP）,respiratory rate（RR）,end-of-breath carbon dioxide(P_ETCO₂),propofol effect chamber concentration（Ce）.Record propofol and fentanyl dosages,awakening time（From drug withdrawal to directional recovery,able to answer questions accurately）,recovery time（Enter PACU and return to ward safely）,the incidence of adverse reaction（Bradycardia,low blood pressure,tougue drop,ventilation passage,respiratory depression,assisted breathiug,etc.）werealso recorded.Satisfaction of surgeons and patients were investigated after surgery.RESULTS Eighty-seven patients were enrolled,and three patients in group D1 were excluded from the studybecause of neuromuscular blocking agent use.P_ETCO₂,RR,MAP were not significantly lower ingroup D2 than group D1,and respiratory was stable（P<0.05）.HR was not significantly lower ingroup D2 than group D3,and the patients maintaining stablehemodynamic（P<0.05）.The rate ofglossocoma,apnea and hypotension is 51.9%,18.5%,25.9%respectively in group D1,the rate ofbradycardia is 93.3%in group D3;there was significant statisticaldifference with group D2（P<0.05）.Doseof propofol and fentanyl decreased in group D2 and D3 compared with group D1（P<0.05）.Therewas no significant difference in operative time,and the satisfaction rate of both patients and operators between the three groups（P>0.05）.CONCLUSIONCompared with dexmedetomidine0.3 and 0.9μg·kg^-1,dexmedetomidine0.6μg·kg^-1 intravenous infusion reduced dosage of general anesthetic drugs,better kept the stability of respiration and circulation,and shortened the recovery time.Combined use of dexmedetomidine can reduce the dosage of propofol and opioids,and correspondiugly reduce the impact on the respiratory and circulatory system.