RESUMO
Objective To evaluate the efficacy of dexmedetomidine and dezocine used to supplement awake tracheal intubation assisted by fiberoptic bronchoscope (FOB) in elderly patients.Methods Sixty elderly patients aged 65-77 yr,of ASA physical status Ⅱ or Ⅲ (Mallampati grade Ⅰ or Ⅱ),scheduled for elective surgery under general anesthesia,were randomly divided into 3 groups (n =20 each) using a random number table:dezocine group (group DEZ),dexmedetomidine group (group DEX) and dezocine combined with dexmedetomidine group (group DEZ+DEX).Dezocine 0.1 mg/kg was injected intravenously in group DEZ.Dexmedetomidine 0.4 μg/kg was infused intravenously over 10-15 min in group DEX.In group DEZ+DEX,dexmedetomidine 0.4 μg/kg was infused intravenously over 10-15 min,and dezocine 0.1 mg/kg was injected simultaneously.Laryngeal mucous membrane was sprayed with 2％ lidocaine for topical anesthesia during infusion in all the three groups.In addition,1％ tetracaine 3 ml was injected into trachea through cricothyroid membrane.Awake tracheal intubation was performed and assisted by FOB after the end of administration in all the three groups.Cardiovascular response (MAP or HR＞30％ of baseline values) and respiratory depression (SpO2＜90％ and RR＜8 bpm) were recorded during the period between induction of anesthesia and 3 min after intubation was completed.The intubation time was recorded.The tolerance of tracheal tube was assessed in the patients.At the time of topical anesthesia,when epiglottis came into view,immediately after tracheal tube was successfully inserted into trachea,and at 3 min after successful intubation,perfusion index and Ramsay sedation score,and patients' satisfaction with the sedation (Ramsay sedation score 2-4) were recorded.Results Compared with group DEZ or DEX,the tolerance of tracheal tube was significantly enhanced,intubation time was shortened,the rate of satisfactory sedation was increased,perfusion index and the incidence of cardiovascular response were decreased in DEZ+DEX group.There was no significant difference in respiratory depression among the three groups.Conclusion Dexmedetomidine and dezocine can provide better condition for awake tracheal intubation assisted by FOB than dexmedetomidine or dezocine alone in elderly patients.
RESUMO
Objective To evaluate the effects of dexmedetomidine on the cellular immune function during analgesia with morphine after radical resection for esophageal cancer in the patients.Methods Sixty patients of both sexes,of ASA physical status Ⅰ or Ⅱ,after radical resection for esophageal cancer under general anesthesia,were randomly divided into 2 groups (n =30 each) using a random number table:control group (group C) and dexmedetomidine group (group Dex).Patient-controlled intravenous analgesia (PCIA) was performed immediately after operation in the two groups.In group C,the PCIA solution (150 ml) contained morphine 0.48 mg/kg.In group Dex,the PCIA solution (150 ml) contained morphine 0.48 mg/kg and dexmedetomidine 1 μg/kg.The postoperative visual analogue scale (VAS) scores were maintained ≤ 3.The consumption of morphine was recorded within 24,48 and 72 h after operation.The adverse effects such as nausea,vomiting,pruritus,bradycardia,hypotension,oversedation and respiratory depression were also recorded after operation.Before induction of anesthesia (T0),immediately after extubation (T1),and at 24,48 and 72 h after operation (T2-4),venous blood samples were obtained for determination of the levels of T-lymphocyte subsets (CD3+,CD4+,CD8+) and natural killer (NK) cells by flow cytometry.CD4+/CD8+ ratio was calculated.Results Compared with group C,the consumption of morphine within 24,48 and 72 h after operation and incidence of nausea,vomiting and pruritus after operation were significantly decreased in group Dex.The levels of CD3+,CD4+,CD4+/CD8+ ratio and NK cells were significantly lower at T1-4 than at T0 in the two groups.The levels of CD3+,CD4+,CD4+/CD8+ ratio and NK cells were significantly higher at T1-4 in group Dex than in group C.Conclusion Dexmedetomidine can improve the cellular immune function during analgesia with morphine after radical resection for esophageal cancer in the patients.