Application effect of dexmedetomidine combined with nitroglycerinin minimally invasive resection of pituitary adenoma through nose

Objective: To explore the clinical application of dexmedetomidine combined with nitroglycerin in minimally invasive resection of pituitary adenoma through nose,and assess its effectiveness,safety and practicality.Methods: Forty patients scheduled by minimally invasive resection of pituitary adenoma through nose were randomly divided into the D group and C group.The D group(dexmedetomidine group) were intravenously injected with a loading lose of dexmedetomidine(1 μg·kg^-1·10 min^-1) 10 min before anesthesia induction by micro-injection pump,following by a continuous infusion at a rate of 0.4 μg·kg^-1·h^-1,and the C group were injected with 0.9% sodium chloride injection in the same way.The mean arterial pressure of all patients were maintained for between 60 and 70 mmHg using nitroglycerin,and the propofol infusion speed was adjusted according to the bispectral index in order to maintain the bispectral index for between 40 to 50.The blood pressure and heart rate in all patients were observed,the intraoperative Fromme operative field quality score,operation time,blood loss,and average dose of propofol and nitroglycerin of all patients were recorded.The time of postoperative spontaneous breathing recovery,awakening and extubation were recorded.The ramsay sedation scores at extubation and after 1 h and 2 h of extubation,the occurrence of shivering and over-sedation within 2 h after extubation were also recorded.Results: Compared with the C group,less blood loss,lower Fromme score,short operation time and lower heart rate during the controlled hypotension period in D group were found(P<0.05 to P<0.01).Compared with the C group,the fluctuating of mean arterial pressure and heart rate and hemodynamics in D group were smaller and stabler at the moment of endotracheal intubation and extubation(P<0.01).The average dose of propofol and nitroglycerin in D group were significantly lower than those in C group(P<0.01).The differences of the time of awakening and extubation between two groups were not statistically significant(P>0.05).The Ramsay sedation scores at extubation and after 1 h of extubation in D group were higher and lower than that in C group,respectively(P<0.01).The difference of Ramsay sedation score between two groups after 2 h of extubation was not statistically significant(P>0.05).The incidence of shivering in D group was lower than that in C group C(P<0.05).Conclusions: The clinical application of dexmedetomidine combined with nitroglycerin in minimally invasive resection of pituitary adenoma through nose can significantly improve the operative score,shorten operation time,obtain better sedation effect and inhibit phenomenon of excessive sedation,which is effective,practicable and safe.