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 group A and group B according to the random number table method (290 cases in 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 factor-α (TNF-α), recovery time, postoperative pain (VAS) score and Ramsay sedation score, opioid and sedation 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 group A at T2–T5 was significantly higher than that in group B (P ＜ 0.01). After 30 min 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 group A was significantly higher than that in group B (P ＜ 0.01). The levels of MDA, MPO and TNF-α were significantly higher than those before surgery (P ＜ 0.05), and those in group A were significantly lower than those in group B (P ＜ 0.01). The recovery time of group A was significantly shorter than that of group B (P ＜ 0.01). After 6, 12, 24, 48 h of surgery, the VAS scores and Ramsay sedation scores in two groups gradually decreased (P ＜ 0.05), and which in group A was significantly lower than that in group B (P ＜ 0.01). The dosage of fentanyl and propofol in group A were lower than those in group B (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.
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