Abstract
ABSTRACTObjectives:To evaluate the sedative and analgesic effects of dexmedetomidine combined with propofol intravenous anesthesia in laparoscopic day surgery in pediatric urology.Methods:Eighty male children with cryptorchidism and hydrocele who underwent laparoscopic daytime surgery in our hospital from January 2019 to January 2021 were selected and randomly divided into two groups: the experimental group and the control group. Children in the experimental group ranged in age from 5.7 to 11.3, with an average of 8.52±2.17 years old, while those in the control group ranged in age from 5.3 to 12.0, with an average of 8.60±2.07 years old. There were 12 cases of cryptorchidism and 28 cases of hydrocele in the experimental group, and 14 cases of cryptorchidism and 26 cases of hydrocele in the control group. Children in the control group received conventional propofol intravenous combined anesthesia, while those in the experimental group were given dexmedetomidine (2-5 ug/kg) intranasally on the basis of conventional propofol intravenous anesthesia. The anesthetic effect, analgesic effect, serum levels of inflammatory cytokines before and after surgery and adverse drug reactions in the two groups were compared and analyzed.Results:The awakening time, extubation time and retention time in the resuscitation room of the experimental group were shorter than those of the control group, with a statistically significant difference (P<0.05); The VAS pain scores of the experimental group were significantly lower than those of the control group at 15minutes, 12hour and 24hour after awakening, with a statistically significant difference (P<0.05). In addition, the levels of TNF-a, CRP, IL-6 and other inflammatory factors in the control group were significantly higher compared with those in the experimental group 24h after surgery, with a statistical significance (TNF-a, P=0.02; CRP, P=0.00; IL-6, P=0.03); The incidence of adverse drug reactions in the experimental group was 17.5%, while that in the control group was 12.5%, which was not statistically significant (P=0.53).Conclusion:Dexmedetomidine combined with intravenous propofol anesthesia may be helpful to shorten the extubation time, the recovery time and the stay time in the anesthesia resuscative room, improve the analgesic effect, and may reduce the inflammatory response and the expression of serum inflammatory cytokines, with no significant increase in side effects.
Highlights
Cryptorchidism and hydrocele are the most common pediatric urological diseases primarily caused by congenital developmental abnormalities.[1,2] Pa-Pak J Med Sci January - February 2022 Vol 38 No 1 www.pjms.org.pk 150Xiao-dan Wang et al.tients with this disease suffer from changes in the normal developmental environment of the testis, and abnormalities in testicular microstructures may result if left untreated, affecting spermatogenesis.[3]
Such a surgical scheme has the advantages of convenience, speed and low cost, which is very suitable for the surgical treatment of cryptorchidism and hydrocele in children
Propofol is an intravenous anesthetic with the advantages of rapid onset, less irritation of the respiratory tract and rapid recovery, which is widely applied in pediatric laparoscopic surgery
Summary
Cryptorchidism and hydrocele are the most common pediatric urological diseases primarily caused by congenital developmental abnormalities.[1,2] Pa-Pak J Med Sci January - February 2022 Vol 38 No 1 www.pjms.org.pk 150Xiao-dan Wang et al.tients with this disease suffer from changes in the normal developmental environment of the testis, and abnormalities in testicular microstructures may result if left untreated, affecting spermatogenesis.[3]. In the wake of the rapid development of minimally invasive technology, laparoscopy has become the standard treatment for cryptorchidism and hydrothecysis in children, featuring advantages such as less trauma, fewer concurrent symptoms and quick postoperative recovery.[4] Day surgery, as a new surgical scheme proposed in recent years, refers to some surgeries with low risk of hospitalization on the day of surgery and discharge on the second day after surgery.[5] Such a surgical scheme has the advantages of convenience, speed and low cost, which is very suitable for the surgical treatment of cryptorchidism and hydrocele in children It is, of great significance to choose appropriate anesthetic drugs and anesthesia methods, due to the children’s younger age, poor adaptability, insufficient psychological maturity, poor treatment compliance and cooperation, and short hospitalization observation time for day surgery.[6] Propofol is an intravenous anesthetic with the advantages of rapid onset, less irritation of the respiratory tract and rapid recovery, which is widely applied in pediatric laparoscopic surgery. Dexmedetomidine nasal drops combined with propofol intravenous anesthesia was applied in pediatric daytime laparoscopic surgery, obvious analgesic and sedative effects were achieved, and no adverse reactions were significantly increased
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