Effect of dexmedetomidine combined with spinal-epidural anesthesia on laparoscopic ovarian cyst surgery
Objective To investigate the anesthetic effect of dexmedetomidine combined with lumbar epidural anesthesia on laparoscopic ovarian cyst surgery and its influence on cognitive function and stress response.Methods A total of 108 patients with ovarian cysts admitted to Ankang People's Hospital from January 2020 to August 2023 were selected,and were divided into a control group and a study group by the random number table method,with 54 cases in each group.The control group were(49.85±5.68)years old,with a body mass index of(23.01±1.59)kg/m2 and a disease course of(4.62±0.71)years.There were 20 cases of grade Ⅰ and 34 cases of grade Ⅱ of American Society of Anesthesiologists(ASA)in the control group.The study group were(51.05± 6.23)years old,with a body mass index of(23.18±1.47)kg/m2 and a disease course of(4.79±0.76)years;there were 18 cases of grade Ⅰ and 36 cases of grade Ⅱ of ASA in the study group.The control group were given midazolam and combined spinal-epidural anesthesia,and the study group dexmedetomidine and combined spinal-epidural anesthesia.The perioperative hemodynamics,intraoperative shivering,pain,cognitive function,stress response,inflammatory response,and adverse reactions were compared between the two groups using t,LSD-t,and x2 tests.Results The mean arterial pressures and heart rates before anesthesia induction(T0),at skin incision(T1),anesthesia for half an hour(T2),and at the end of operation(T3)were(93.02±5.97)mmHg(1 mmHg=0.133 kPa),(81.03±4.86)mmHg,(84.51±6.24)mmHg,and(86.12±4.05)mmHg and(83.73±5.16)times/min,(68.76±4.16)beats/min,(74.31±4.13)beats/min,and(76.02± 4.84)beats/min in the study group,and were(94.16±6.08)mmHg,(84.58±5.12)mmHg,(83.67± 5.73)mmHg,and(89.73±4.14)mmHg and(84.59±5.01)beats/min,(72.32±4.85)beats/min,(76.85± 4.26)beats/min,and(79.88±5.01)beats/min in the control group;there were statistical differences in the mean arterial pressure and heart rate between different time points in both group(F=9.143 and 8.769;both P＜0.001);there were statistical differences in the mean arterial pressure and heart rate between the two groups(F=8.371 and 8.416;both P＜0.001);there were statistical differences in the mean arterial pressure and heart rate change trends between the two groups(F=9.168 and 9.316;both P＜0.001).The incidence of shivering in the study group was lower than that in the control group[5.56％(3/54)vs.18.52％(10/54);x2=4.285,P=0.038].The scores of Visual Analogue Scale(VAS)4,12,and 24 h after the surgery in the study group were(2.17±0.36),(3.07± 0.38),and(2.45±0.41),and those in the control group were(2.21±0.39),(3.38±0.42),and(2.69± 0.43);there was a statistical difference in the score between different time points(F=9.054;P＜0.001);there was a statistical difference in the score between the two groups(F=8.031;P＜0.001);there was a statistical difference in the change trend of VAS score between the two groups(F=7.968;P＜0.001).Before and 12 and 24 h after the operation,there were no statistical differences in the score of The Mini-mental State Examination(MMSE)between the time points and in the score change trend between the two groups(all P＞0.05).Twenty-four hours after the operation,the levels of epinephrine,cortisol,and reactive oxygen species in the study group were(112.35±15.71)ng/L,(298.47±40.12)nmol/L,and(115.71±12.89)mmol/L,and those in the control group were(126.54± 18.67)ng/L,(321.54±45.13)nmol/L,and(127.54±15.32)mmol/L,which were higher than those before the operation;those in the study group were lower than those in the control group[t=4.274,P＜0.001;t=2.807,P=0.006;t=4.342,P＜0.001].Twenty-four h after the operation,the levels of interleukin-6(IL-6),interleukin-21(IL-21),and high mobility group protein B1(HMGB1)in the study group were(40.02±4.93)ng/L,(9.02±1.51)ng/L,and(42.76±5.01)ng/L],and those in the control group were(43.98±5.27)ng/L,(10.17±1.69)ng/L,and(46.89±5.84)ng/L,which were higher than those before the operation;the levels of IL-6,IL-21,and HMGB1 in the study group were lower than those in the control group(t=4.032,3.729,and 3.944;all P＜0.001).There was no statistical difference in the total incidence of adverse reactions between the two groups(x2=0.375,P=0.540).Conclusion Dexmedetomidine combined with spinal-epidural anesthesia for laparoscopic ovarian cyst resection has significant anesthetic effect,and helps maintain the stability of perioperative hemodynamics,reduce the risk of intraoperative shivering,relieve perioperative pain,stress,and inflammation,does not affect the patients'cognitive function,and is safe and reliable.
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