ABSTRACT
Objective:To evaluate the efficacy of combination of dexmedetomidine and compound lidocaine cream for the prevention and treatment of the stress responses during recovery from general anesthesia in the patients undergoing transnasal transphenoidal pituitary adenoma resection.Methods:A total of 90 patients, aged 18-64 yr, with body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing elective pituitary tumor resection by transsphenoidal approach with general anesthesia, were divided into 3 groups ( n=30 each) by the random number table method: combination of dexmedetomidine and compound lidocaine cream group (D-L group), dexmedetomidine group (D group) and compound lidocaine cream group (L group). Compound lidocaine cream 2 g was applied to the anterior 1/3 of the tracheal tube and surface of the cuff in D-L and L groups, and paraffin oil was applied to the surface of the tracheal tube in group D. In D-L and D groups, dexmedetomidine 0.5 μg/kg was intravenously infused for 10 min at 30 min before the end of surgery, while the equal volume of normal saline was given in group L. Heart rate and mean arterial pressure were continuously monitored during peritracheal extubation, and the occurrence of responses to extubation was recorded.The optic nerve sheath diameter (ONSD) was measured by ultrasound after entering the operating room(t 0), after anesthesia induction(t 1), and at 5 min after extubation (t 2). The bucking and agitation scores were recorded during recovery from anesthesia. Results:Compared with group D and group L, the incidence of bucking and responses to extubation was significantly decreased in group D-L (27%, 37%, 6%; 23%, 27%, 3%, respectively, P<0.05). Compared with group L, the incidence of agitation was significantly decreased in D-L and D groups (37%, 10%, 13%, respectively, P<0.05). No severe bucking and agitation occurred in group D-L.There was no significant difference in ONSD at each time point among three groups ( P>0.05). Conclusion:Combination of dexmedetomidine and compound lidocaine cream performs better than either alone and can prevent and treat stress responses during recovery from general anesthesia in the patients undergoing transnasal transsphenoidal pituitary adenoma resection.