Effect of dexmedetomidine combined with propofol and remifentanil in anesthesia during LC and influ-ence on hemodynamics of patients
Objective To explore the effect of dexmedetomidine combined with propofol and remifentanil in anesthesia during laparoscopic cholecystectomy(LC)and its influence on hemodynamics of patients.Methods A total of 146 patients who underwent LC in Jiashan Country Traclitional Chinese Medicine Hospital from January 2019 to June 2023 were selected as the study subjects.They were divided into two groups:the propofol group(n=73)and the combined group(n=73)according to treatment method.Both groups were intravenously induced general anesthesia.The control group was given propofol and remifentanil during anesthesia induction and anesthesia maintenance.On the basis of anesthesia in the control group,the combined group was intravenously infused with 0.5 μg/kg dexmedetomidine at 10～15 min before anesthesia induction and then was infused with a maintenance dose of 0.2～0.8 μg·kg-1·h-1 until 30 min before the end of surgery.Compared the hemodynamic indicators[central venous pressure(CVP),mean arterial pressure(MAP),heart rate(HR)]in these two groups before the anesthesia induction,after the intubation,during the resection and at the end of surgery,and compared the anesthetic effect(anesthesia duration,extubation time,time of spontaneous breathing recovery,time of recovering consciousness),analgesic effect[Visual Analogue Scale(VAS),sedation(Ramsay sedation score)]at 1 hour,4 hours,8 hours and 12 hours after surgery in the two groups.Also compared the pain stress indicators[C-reactive protein(CRP),cortisol(COR),adrenocorticotropic hormone(ACTH),total bile acid(TBA)]before surgery and at 24 hours after surgery between the two groups.The adverse reactions were recorded.Results MAP,CVP,and HR were compared between groups,at time points,and interaction of between-group× time-point,and the differences were statistically significant(P＜0.05).From anesthesia induction to the resection,MAP,CVP and HR in propofol group gradually decreased and increased at the end of surgery(P＜0.05).MAP,CVP and HR in the combined group were significantly higher than those before induction and at the end of surgery during resection(P＜0.05),and there was no significant difference between the other time points or before anesthesia induction(P＞0.05).MAP,CVP and HR in combined group after intubation were(88.2±4.0)mmHg,(0.77±0.15)kPa,(77.6±5.1)times/min and the indicators during the resection were(87.5±4.5)mmHg,(0.74±0.16)kPa,(76.8±5.1)times/min,which were significantly higher than those in propofol group[(85.8±3.2)mmHg,(0.71±0.18)kPa,(75.4±5.1)times/min and(83.3±2.6)mmHg,(0.6±0.16)Kpa,(74.1+4.7)times/min](P＜0.05).There was no significant difference in the anesthesia duration between the two groups(P＞0.05).The time from the end of surgery to extubation,time of spontaneous breathing recovery,and time of recovering consciousness in the combined group were(5.5±l.l)min,(4.9±1.1)min,and(6.0±1.1)min,which were significantly shorter than those in propofol group[(6.0±1.4)min,(5.3±1.3)min and(6.4±1.3)min](P＜0.05).VAS score and Ramsay sedation score were compared between groups,at time points,and between groups × time points,and the differences were statistically significant(P＜0.05).The VAS score in the two groups gradually increased at 1～8 hours after surgery,and decreased at 12 h after surgery(P＜0.05)while the Ramsay score gradually decreased at 1～8 hours after surgery and increased at 12 h after surgery(P＜0.05).In the combined group,the VAS score at 1～12 hours after surgery were(2.4±0.5),(3.1±0.5),(3.8±0.6),and(3.5±0.6),which were significantly lower than that in propofol group[(2.5±0.6),(3.5±0.6),(4.2±0.6)and(3.9±0.6)](P＜0.05).In comparison,the Ramsay sedation score were(4.1±0.6),(3.6+0.5),(2.9±0.5),and(3.4±0.4),which were significantly higher than that in propofol group[(3.9±0.5),(3.4±0.5),(2.7±0.5)and(3.2±0.4)](P＜0.05).CRP,COR,ACTH,and TBA were significantly raised in both groups at 24 hours after surgery(P＜0.05).CRP,COR,ACTH,and TBA in compound group were(48.7±5.8)mg/L,(246.4±22.1)nmol/L,(89.7±6.5)pg/ml and(15.3±2.9)μmol/L,which were significantly lower than those in propofol group at 24 hours after surgery[(52.6±5.6)mg/L,(258.6±23.5)nmol/L,(93.8±6.3)pg/ml and(16.6±3.1)µmol/L](P＜0.05).The incidence of anaesthesia related adverse reactions was 9.6％in the combined group and 6.8％in the propofol group,with no significant difference between the two groups.(x2=0.468,P＞0.05).Conclusion Dexmedetomidine combined with propofol and remifentanil has a good anesthetic effect during LC surgery.This anesthesia method has little hemodynamics intervention,good analgesic and sedative effect,and high safety,which is worthy of recommendation
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