Effects of different doses of dexmedetomidine combined with propofol and remifentanil target controlled infusion on postanesthesia recovery of patients in functional endoscopic sinuses surgery

Abstract

Objective To investigate the effects of different doses of dexmedetomidine combined with propofol and remifentanil target controlled infusion (TCI) on postanesthesia recovery of patients in functional endoscopic sinus surgery. Methods Eighty ASA Ⅰ or Ⅱ grade patients, scheduled for the endoscopic sinus surgery, were divided into control group (20 cases) and dexmedetomidine group (60 cases) according to the random digits table method. The patients in dexmedetomidine group were given loading dose dexmedetomidine 0.6 µg/kg, then were given dexmedetomidine of different maintenance doses: 0.3 µg/(kg·h) in D1 group, 0.6 µg/(kg·h) in D2 group and 0.9 µg/(kg·h) in D3 group. The patients in dexmedetomidine group were given TCI propofol and remifentanil during the maintenance of general anesthesia, rocuronium was administrated intermittently during operation, and bispectral index (BIS) was controlled at 40 -50. The changes of hemodynamics 5 -10 min after entering operation room (T0), before induction (T1), 1 min after intubation (T2), 5 min after intubation (T3), before extubation (T4) and 5 min after extubation (T5) were observed. The spontaneous breathing recovery time, call of eye-opening time, extubation time and adverse reaction after surgery were recorded. Moreover, the visual analogue score (VAS) and Ramsay sedation score were used to evaluate the comfort level of patients. Results The mean arterial pressure (MAP) at T5 in control group and D1 group were significantly higher that in D2 group and D3 group, and there were statistical differences (P 0.05). The VAS 15 min after extubation in D1 -D3 group were significantly lower than that in control group: (3.7 ± 0.3), (3.1 ± 0.4) and (3.0 ± 0.5) scores vs. (6.2 ± 0.6) scores, and there were statistical differences (P<0.05). The Ramsay sedation scores in D1 -D3 group were significantly higher than that in control group: (2.5 ± 0.2), (2.7 ±0.2) and (5.3 ± 0.3) scores vs. (1.4 ± 0.3) scores. Moreover, Ramsay sedation score in D3 group was significantly higher than that in D1 group and D2 group, and Ramsay sedation score in D2 group was significantly higher than that in D1 group. There were statistical differences (P <0.05). Four and 2 patients occurred nausea vomiting respectively in control group and D1 group within 24 h after operation. Conclusions Dexmedetomidine combined with propofol and remifentanil TCI can maintain hemodynamic stability and improve anesthesia recovery quality. Key words: Anesthesia, intravenous; Paranasal sinus diseases; Dexmedetomidine; Functional endoscopic sinus surgery