Comparison of the anesthetic effect of remazolam and dexmedetomidine in ultrasound-guided brachial plexus block for replantation of severed finger / 实用医学杂志

ABSTRACT

Objective To compare the anesthetic effects of remazolam and dexmedetomidine assisted sedation in the operation of finger replantation under ultrasound guided brachial plexus block.Methods 60 patients undergoing severed finger replantation were randomly divided into remazolam group(group R)and a dexmedetomidine group(group D)by random number table method,with 30 cases in each group.Both groups received a single brachial plexus block under ultrasound guidance.Group R was injected with remazolam 0.1 mg/kg,followed by 1 mg/(kg·h)pump until 10 min before the end of the operation.In group D,a load dose of 0.5 μg/kg of dexmedetomidine was injected,followed by continuous infusion at a rate of 0.5 μg/(kg·h)until 10 min before the end of surgery.The MAP,HR and SpO2 values of the two groups were compared when the patients entered the room(T0),the wound was cleaned and disinfected(T1);the tourniquet was upper(T2);the operation began(T3);the tourniquet was relaxed(T4);and the operation ended(T5).MOAA/S scores and BIS values were compared between the two groups at different time.The time from the beginning of medication to the absence of consciousness and the time of consciousness recovery after drug withdrawal were compared between the two groups.Blood lactic acid(Lac)before applying tourniquet and 15 min after relaxing tourniquet were compared between the two groups.The occurrence of intraoperative adverse reactions was recorded in the two groups.Results The MAP of patients in group R had little fluctuation at each time during the operation,and the MAP of patients in group D was significantly increased at T1,T2,T3 and T0 moments and at the same time as that in group R(P<0.05);HR in group R was stable at all times,and HR in group D significantly slowed down at T1,T2 and at the same time with group R(P<0.05).Patients in both groups achieved ideal sedation during the operation(MOAA/S score≤3 points),and the MOAA/S score of patients in group R at T5 minutes after drug withdrawal was higher than that at other moments of the same group and group D(P<0.05);the BIS value of group R was higher than that of group D(P<0.05).The loss time and recovery time of consciousness in group R were shorter than those in group D(P<0.05).The incidence of intraoperative hypertension and bradycardia in group D was significantly higher than that in group R,and the incidence of respiratory depression in group R was higher than that in group D(P<0.05).There was no significant change in lactate value between the two groups(P>0.05).Conclusion Remazolam and dexmedetomidine can satisfy sedation in brachial plexus nerve block for replantation of severed finger under ultrasound guidanc.Compared with dexmedetomidine,remazolam has better sedation control,stable hemodynamics,low incidence of circulatory adverse events.