ABSTRACT
Objective To investigate the clinical efficacy and safety of dexmedetomidine combined with sevoflurane in elderly patient undergoing percutaneous nephrolithotomy.Methods Forty ASA Ⅰ ～ Ⅱ elderly patients of both sexes,aged 65 ～ 76 (71.0 ± 6.0)yr,scheduled for elective surgery of percutaneous nephrolithotomy under general anesthesia,were randomly divided into two groups (n =20 each):dexmedetomidine/sevoflurane group (group D) and propofol/sevoflurane group (group P).All patients received fentanyl,propofol,and cisatracurium for anesthesia induction.After endotracheal intubation,patients in group D received an initial loading dose of 0.5 μg/kg (4 μg/ml) of dexmedetomidine over 10 min,followed by a continuous infusion of 0.3 ～ 0.6 μg/(kg · h).Patients in group P received an initial loading dose of 1 mg/kg of propofol over 10 min,followed by a continuous infusion of 3 ～ 6 mg/(kg · h).All patients received the inhalation of sevoflurane for maintenance.Bispectral index was used to maintain a similar level of hypnosis in both groups (40 ～ 60).The heart rate (HR),blood pressure (BP) [systolic blood pressure (SBP)/diastolic blood pressure (DBP)],oxygen saturation (SpO2),end-tidal carbon dioxide partial pressure (PETCO2) at different time points before anesthesia (T0),10 min after prone position (T1),30 and 60 min started lithotripsy (T2-3),and at the end of operation (T4) were recorded,respectively.The operation time,amount of blood loss,and volume of fluid infusion were recorded.Recovery time of spontaneous ventilation,awaking time (open eyes by calling),extubation time,staying time at postanesthesia care unit (PACU),and relevant complications were also recorded.Results Compared to the baseline value at T0,SBP and DBP were significantly decreased at T1 in both groups(P ＜0.05),and no significant differences in the SBP,DBP,SpO2,and PETCO2 were found between two groups(P ＞ 0.05).Compared to the baseline value at T0,the HR was significantly decreased at T1 ～ T4 in group D (P ＜ 0.05),the HR was significantly lower at T1 ～ T4 in group D than that of group P (P ＜ 0.05).No significant differences in operation time,amount of blood loss,and volume of fluid infusion were found between two groups (P ＞ 0.05).No significant differences in recovery time of spontaneous ventilation,staying time at PACU,nausea,vomit,and agitation were found between two groups (P ＞ 0.05),while awaking time and extubation time were significantly longer in group D than that of group P(P ＜ 0.05).The shivering was significantly less in group D than that of group P (P ＜ 0.05).Conclusions Both dexmedetomidine/sevoflurane and propofol/sevoflurane anesthesia are suitable for elderly patients undergoing percutaneous nephrolithotomy.Dexmedetomidine/sevoflurane makes time of awake and extubation longer,but dexmedetomidine can reduce the shivering and the attendant complications caused by shivering.