Multi-mode administration of dexmedetomidine for thoracic surgery anesthesia / 中国医师进修杂志

ABSTRACT

Objective To investigate the reasonable and effective administration ofdexmedetomidine for thoracic surgery anesthesia.Methods Eighty ASA Ⅰ-Ⅱ patients,aged 18-60 years old scheduled for elective thoracotomy were randomly assigned to 4 groups(each 20 patients).Group Adexmedetomidine before anesthesia induction + bupivacaine before closed thorax cavity.Group Bdexmedetomidine before anesthesia induction + dexmedetomidine and bupivacaine before closed thorax cavity.Group C0.9％ sodium chloride before anesthesia induction + bupivacaine before closed thorax cavity.Group D0.9％ sodium chloride before anesthesia induction + dexmedetomidine and bupivacaine before closed thorax cavity.Mean arterial pressure (MAP) and heart rate (HR) were measured before infusing dexmedetomidine or 0.9％ sodium chloride (T0),after infusing dexmedetomidine or 0.9％ sodium chloride (T1),instant time after intubation (T2) and 3 min after intubation (T3),5 min after intubation (T4).The scores of visual analogue scale(VAS) and the consumption of analgesics were compared.Results There was no significant difference including gender,age,weight and operation time among four groups (P ＞ 0.05).Compared with T0,MAP and HR were significantly decreased at T1 in group A and group B (P ＜ 0.05),and were significantly increased at T2 in group C and group D (P＜ 0.05).Respectively compared with group A and group B,MAP and HR were significantly increased at T2,T3 in group C and group D (P ＜ 0.05).The scores of VAS in group B [(2.47 ± 1.43) scores] and group D [(2.00 ± 1.68) scores] were lower than those in group A [(4.78 ± 1.26) scores] and group C [(4.88 ± 1.62) scores] after operation 12 h.The times of using postoperative analgesics in group B [(0.6 ± 0.4) times] and group D [(0.8 ± 0.1) times] were significantly less than those in group A [(1.3 ± 0.5) times]and group C [(1.5 ± 0.4) times] (P ＜ 0.05).Conclusions Intravenous dexmedetomidine before anesthesia induction can control the effect of double-lumen endobronchial tube responses and make hemodynamics stable.Intercostal nerve block with 0.5 μ g/kg bupivacaine and 0.375％ dexmedetomidine can enhance the analgesia effect and prolong the analgesia time.