Objective To investigate the effects of two timing of dexmedetomidine administration on opioid and sedation dosage, ischemia-reperfusion injury, and anesthesia awakening in geriatric hip fracture surgery under general anesthesia.
Methods Five hundred and eighty elderly patients with hip fracture were divided into A and B groups according to the random number table method (290 cases each group). General anesthesia was administered in both groups, and Group A was given dexmedetomidine before anesthesia induction, group B was given dexmedetomidine after anesthesia induction. The hemodynamicsmean arterial pressure (MAP) and heart rate (HR), ischemia-reperfusion injury indexessuperoxide dismutase (SOD), malondialdehyde (MDA), myeloperoxidase (MPO) and tumor necrosis cytokines α(TNF-α), recovery time, postoperative pain (VAS) score and Ramsay sedation score, opioid and sedative dosage and adverse reaction rate were compared between two groups at different time points.
Results The HR and MAP in two groups at T1-T5 were lower than those at T0 (P ＜ 0.05), but there was no statistical significance in the HR at T1 to T5 between two groups (P ＞ 0.05). There was no statistical significance in the MAP between two groups at T0 and T1 (P ＞ 0.05). The MAP in the A group at T2 to T5 was significantly higher than that in B group (P ＜ 0.01). After 30min of operation and at the end of operation, the serum levels of SOD in two groups were lower than that before operation (P ＜ 0.05), and which in the A group was significantly higher than that in B group (P ＜ 0.01); The levels of MDA, MPO and TNF-α levels were significantly higher than those before surgery (P ＜ 0.05), and those in A group were significantly lower than those in B group (P ＜ 0.01). The recovery time of A group was significantly shorter than that of B group (P ＜ 0.01). After 6 h, 12 h, 24 h and 48 h of surgery, the VAS scores and Ramsay sedation scores in two groups gradually decreased (P ＜ 0.05), and which in A group was significantly lower than that in B group (P ＜ 0.01). The dosage of fentanyl and propofol in A group were lower than those in B group (P ＜ 0.01); There was no statistical significance in the incidence of adverse reactions between two groups (P ＞ 0.05).
Conclusions Compared with after anesthesia induction, the dexmedetomidine infusion before anesthesia induction can stabilize hemodynamics, improve sedation and sedation effect, reduce ischemia reperfusion injury, improve anesthesia recovery quality, reduce the dosage of analgesic and sedative drugs, and has good safety.
DownLoad: