RESUMEN
Objective To explore the application value of retrobulbar nerve block combined with general anesthesia in the penetrating keratoplasty (PKP). Methods A total of 100 recipients undergoing PKP from January 2017 to January 2019 were recruited in this study. All recipients were divided into the observation group (n=50) and control group (n=50) by random number table method. In the control group, patients received laryngeal mask airway under general anesthesia, and in the observation group, patients received laryngeal mask airway under general anesthesia combined with retrobulbar nerve block. Hemodynamic changes of the PKP recipients before and after operation were observed in two groups. The dosage of analgesic drugs and the incidence of complications were observed in two groups. The degree of pain at postoperative 2-, 6- and 24-h was evaluated by visual analogue scale (VAS) in two groups. The awakening situation of the recipients in two groups was observed. The levels of inflammatory cytokines at 1 d before and after operation were statistically compared in two groups. Results The average arterial pressure and heart rate at intraoperative 15 min and after the surgery in the observation group were significantly higher than those in the control group (both P < 0.05). In the observation group, the dosage of remifentanil and propofol were (1.0±0.4) mg and (299±40) mg, significantly lower than (1.3±0.6) mg and (365±42) mg in the control group (both P < 0.05). The incidence of complications did not significantly differ between two groups (P > 0.05). In the observation group, the VAS scores at 2-, 6- and 12-h after operation were remarkably lower than those in the control group (all P < 0.01). The respiratory recovery time, eye opening time, directional force recovery time and extubation time of the recipients in the observation group were significantly shorter than those in the control group (all P < 0.05). The expression levels of including interleukin (IL)-1, IL-6 and tumor necrosis factor-α (TNF-α) at postoperative 1 d in the observation group were considerably lower than those in the control group (all P < 0.05). Conclusions Retrobulbar nerve block combined with general anesthesia can maintain hemodynamic stability during PKP, reduce the dosage of remifentanil and propofol and alleviate the degree of postoperative pain and inflammatory responses of the recipients.
RESUMEN
Objective To observe the sedative effect of dexmedetomidine in senile cataract surgery with retrobulbar nerve block.Methods Ninety-three senile cataract patients,ASA Ⅱ or Ⅲ grades,aged from 65 to 82 years old,scheduled for cataract surgery with retrobulbar nerve block were equally randomized into three groups by systematic sampling.The patients in three groups were given bolus infusion dexmedetomidine 0.5 μ g/kg before operation and group A was maintained by 0.2 μ g/ (kg· h),group B was maintained by 0.4 μ g/(kg· h) and group C was maintained by 0.6 μ g/(kg· h).Ramsay score,mean arterial blood pressure (MAP),heart rate (HR),respiratory rate,pulse oxygen saturation (SpO2) were recorded before anesthesia (T0),after retrobulbar nerve block (T1),and after sedative administration for 10 (T2),20 (T3),30 (T4),60 min (T5).Results The operation in three groups was successful.The scores of Ramsay at T2-T5 in three groups was significantly higher than that at T0 [group A:(2.6 ± 0.7),(2.5 ±0.2),(2.4 ±0.8),(2.4 ± 0.3) scores vs.(2.0 ± 0.0) scores;group B:(3.0 ± 0.7),(3.8 ± 0.7),(4.2 ± 0.2),(4.5 ± 0.2)scores vs.(2.0 ± 0.0) scores;group C:(3.8 ± 0.6),(4.7 ± 0.4),(5.2 ± 0.8),(5.6 ± 0.6) scores vs.(2.0 ± 0.0) scores].The scores of Ramsay at T3-T5 in group C was significantly higher than that in group A and group B,the scores of Ramsay in group B was significantly higher than that in group A,there was significant difference (P ＜ 0.05).The HR at T3-T5 in three groups was significantly lower than that at T0 [group A:(77 ± 5),(76 ± 7),(74 ± 12) times/min vs.(88 ± 12) times/min; group B:(72 ± 9),(70 ± 8),(70 ± 11)times/min vs.(90 ± 10) times/min;group C:(64 ±7),(55 ±7),(54 ±6) times/min vs.(88 ±9)times/min],the HR at T3-T5 in group C was significantly lower than that in group A and group B,there was significant difference (P ＜ 0.05).The level of MAP,respiratory rate in three groups and interclass had no significant difference (P＞ 0.05).There was no respiratory depression,nausea,vomiting and dizzy occurred.Conclusion Bolus infusion dexmedetomidine 0.5 μ g/kg followed by intravenous infusion at 0.2-0.4 μ g/(kg·h) is suitable for sedation of elderly patients with cataract surgery.