Impact of dexmedetomidine anesthesia on intraoperative wake-up test in Brucellar spondylitis undergoing surgery

Abstract

Objective To observe the effects of dexmedetomidine on intraoperative wake-up test in Brucellar spondylitis (BS) patients undergoing surgical operation. Methods Using the case control method, thirty-two patients undergoing BS surgical operation from January 2014 to December 2017 in Harbin the Fifth Hospital were enrolled in this study, the patients were randomly classified into the experimental group (n= 16) and the control group (n= 16). The two groups were anesthetized with midazolam, propofol, sufentanil and cisatracurium, then anesthesia was maintained with sevoflurane inhalation and a continuous intravenous infusion of remifentanil. In the experimental group, dexmedetomidine 0.4 μg·kg-1·h-1 was administered after tracheal intubation, while equal volume saline solution was given to control group. When the wake-up test was performed, the values of mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS) were recorded at the time points of preinduction (T0), just before wake-up (T1) and awakening (T2). The wake-up time, the amount of bleeding during the wake-up period, the wake-up quality rating and the sedation score were recorded. Results There was significant difference in HR and MAP at T0, T1 versus at T2 in control group [(98.8 ± 21.0) time/min vs (84.5 ± 8.1), (81.8 ± 1.7) time/min, (90.2 ± 7.5) mmHg vs (76.2 ± 5.7), (74.6 ± 8.5) mmHg, 1 mmHg= 0.133 kPa, P < 0.05]. In experimental group, HR and MAP were lower than those in control group at T2, and the difference between the two groups was statistically significant [(86.3 ± 12.3) time/min vs (98.8 ± 21.0) time/min, (77.9 ± 6.3) mmHg vs (90.2 ± 7.5) mmHg, t=- 2.901,- 4.995, P < 0.05) . The wake-up test quality was significantly better in test group than that in control group, the difference was statistically significant (excellent: 13 cases vs 4 cases, good: 2 cases vs 6 cases, poor: 1 case vs 6 cases, χ2= 4.571, P < 0.05). The wake-up time and the amount of bleeding during wake-up period were less than that in control group, the difference was statistically significant [(14.5 ± 3.6) min vs (26.1 ± 4.5) min, (239.8 ± 53.9) ml vs (317.3 ± 54.8) ml, t=- 7.980, - 4.032, P < 0.05]. Conclusion Dexmedetomidine when continuous pumped at a rate of 0.4 μg·kg-1·h-1 could reduce the hemodynamic stress response during the wake-up test, improve the wake-up test quality, shorten the wake-up time and effectively improve the safety factor of operation during Brucellar surgical operation. Key words: Spondylitis; Brucella; Dexmedetomidine; Intraoperative wake-up test