Application of Dexmedetomidine versus Propofol in elderly patient undergoing transurethral resection of the prostate / 中华老年医学杂志

ABSTRACT

Objective To investigate the efficiency and safety of Dexmedetomidine as adjuvant to local anesthetics in elderly patient undergoing transurethral resection of the prostate.Methods Sixty elderly patients undergoing selective transurethral resection of the prostate were randomly divided into the Dexmedetomidine group and the Propofol group(n =30,each).After block level of spinal anesthesia was determined,Dexmedetomidine(a bolus dose of 0.5 μg/kg for 10 minutes,then continuous injection of 0.2-0.4 μg· kg-1 · h-1)or Propofol(initial plasma concentration of 0.5 mg/L,after getting equal to an effect compartment drug concentration,plasma concentration was gradually increased by 0.1 mg/L)was injected with an infusion pump.Observation items were recorded,including the onset time [observer's assessment of alertness/sedation (OAA/S) ≤ 3 points],blood pressure,heart rate,respiratory rate,pulse oxygen saturation,end-tidal carbon dioxide partial pressure,bispectral index value(BIS),and OAA/S score as well as adverse events and patients' satisfaction to sedation.Results The OAA/S score after 20 minutes of drug injection was lower in the Propofol group than in the Dexmedetomidine group(3.0 ± 0.5 scores vs.3.5 ± 0.6 scores,t =2.300,P =0.030).The systolic pressure levels were lower in the Propofol group than in the Dexmedetomidine group after 30 minutes and 40 minutes of drug injection(107.6 ± 11.2 mmHg vs.119.2 ± 16.4 mmHg,106.7±9.6 mmHg vs.121.2±18.3 mmHg,1 mmHg=0.133 kPa,t =2.151 and 2.555,P=0.041 and 0.017).The diastolic pressure was lower in the Propofol group than in the Dexmedetomidine group after 10 minutes of drug injection(69.8±6.7 mmHg vs.78.0±10.1 mmHg,t =2.462,P =0.021).The incidence of bradycardia was higher in the Dexmedetomidine group than in the Propofol group(20.0％ or 6/30 vs.0.0％ or 0/30,x2 =6.667,P=0.010).The incidences of respiratory depression and involuntary movement were lower in the Dexmedetomidine group than in the Propofol group(0.0％ or 0/30 vs.13.3％ or 4/30,0.0％ or 0/30 vs.30.0％ or 9/30,x2 =4.286 and 10.588,P =0.038 and 0.001).Conclusions Compared with the conventional Propofol,Dexmedetomidine has a definite sedative effect in elderly patients undergoing transurethral resection of the prostate under spinal anesthesia,with peace and cooperation,greater stability of blood pressure,without breath depression,but with higher incidence of bradycardia.