Effect of dexmedetomidine combined with spinal-epidural anesthesia on laparoscopic ovarian cyst surgery

doi:10.3760/cma.j.issn.1007-1245.2024.07.010

Abstract

Abstract:

Objective　To investigate the anesthetic effect of dexmedetomidine combined with lumbar epidural anesthesia on laparoscopic ovarian cyst surgery and its influence on cognitive function and stress response. Methods　A total of 108 patients with ovarian cysts admitted to Ankang People's Hospital from January 2020 to August 2023 were selected, and were divided into a control group and a study group by the random number table method, with 54 cases in each group. The control group were (49.85±5.68) years old, with a body mass index of (23.01±1.59) kg/m² and a disease course of (4.62±0.71) years. There were 20 cases of grade Ⅰ and 34 cases of grade Ⅱ of American Society of Anesthesiologists (ASA) in the control group. The study group were (51.05±6.23) years old, with a body mass index of (23.18±1.47) kg/m² and a disease course of (4.79±0.76) years; there were 18 cases of grade Ⅰ and 36 cases of gradeⅡ of ASA in the study group. The control group were given midazolam and combined spinal-epidural anesthesia, and the study group dexmedetomidine and combined spinal-epidural anesthesia. The perioperative hemodynamics, intraoperative shivering, pain, cognitive function, stress response, inflammatory response, and adverse reactions were compared between the two groups using t, LSD-t, and χ² tests. Results　The mean arterial pressures and heart rates before anesthesia induction (T0), at skin incision (T1), anesthesia for half an hour (T2), and at the end of operation (T3) were (93.02±5.97) mmHg (1 mmHg=0.133 kPa), (81.03±4.86) mmHg, (84.51±6.24) mmHg, and (86.12±4.05) mmHg and (83.73±5.16) times /min, (68.76±4.16) beats/min, (74.31±4.13) beats/min, and (76.02±4.84) beats/min in the study group, and were (94.16±6.08) mmHg, (84.58±5.12) mmHg, (83.67±5.73) mmHg, and (89.73±4.14) mmHg and (84.59±5.01) beats/min, (72.32±4.85) beats/min, (76.85±4.26) beats/min, and (79.88±5.01) beats/min in the control group; there were statistical differences in the mean arterial pressure and heart rate between different time points in both group (F=9.143 and 8.769; both P<0.001); there were statistical differences in the mean arterial pressure and heart rate between the two groups (F=8.371 and 8.416; both P<0.001); there were statistical differences in the mean arterial pressure and heart rate change trends between the two groups (F=9.168 and 9.316; both P<0.001). The incidence of shivering in the study group was lower than that in the control group [5.56% (3/54) vs. 18.52% (10/54); χ²=4.285, P=0.038]. The scores of Visual Analogue Scale (VAS) 4, 12, and 24 h after the surgery in the study group were (2.17±0.36), (3.07±0.38), and (2.45±0.41), and those in the control group were (2.21±0.39), (3.38±0.42), and (2.69±0.43); there was a statistical difference in the score between different time points (F=9.054; P<0.001); there was a statistical difference in the score between the two groups (F=8.031; P<0.001); there was a statistical difference in the change trend of VAS score between the two groups (F=7.968; P<0.001). Before and 12 and 24 h after the operation, there were no statistical differences in the score of The Mini-mental State Examination (MMSE) between the time points and in the score change trend between the two groups (all P>0.05). Twenty-four hours after the operation, the levels of epinephrine, cortisol, and reactive oxygen species in the study group were (112.35±15.71) ng/L, (298.47±40.12) nmol/L, and (115.71±12.89) mmol/L, and those in the control group were (126.54±18.67) ng/L, (321.54±45.13) nmol/L, and (127.54±15.32) mmol/L, which were higher than those before the operation; those in the study group were lower than those in the control group [t=4.274, P<0.001; t=2.807, P=0.006; t=4.342, P<0.001]. Twenty-four h after the operation, the levels of interleukin-6 (IL-6), interleukin-21 (IL-21), and high mobility group protein B1 (HMGB1) in the study group were (40.02±4.93) ng/L, (9.02±1.51) ng/L, and (42.76±5.01) ng/L], and those in the control group were (43.98±5.27) ng/L, (10.17±1.69) ng/L, and (46.89±5.84) ng/L, which were higher than those before the operation; the levels of IL-6, IL-21, and HMGB1 in the study group were lower than those in the control group (t=4.032, 3.729, and 3.944; all P<0.001). There was no statistical difference in the total incidence of adverse reactions between the two groups (χ²=0.375, P=0.540). Conclusion　Dexmedetomidine combined with spinal-epidural anesthesia for laparoscopic ovarian cyst resection has significant anesthetic effect, and helps maintain the stability of perioperative hemodynamics, reduce the risk of intraoperative shivering, relieve perioperative pain, stress, and inflammation, does not affect the patients' cognitive function, and is safe and reliable.

Key words:

Dexmedetomidine, Spinal-epidural anesthesia, Laparoscopy, Ovarian cyst surgery, Effect

摘要：

目的　探讨右美托咪定复合腰硬联合麻醉对腹腔镜卵巢囊肿手术的麻醉效果及对认知功能、应激反应的影响。方法　前瞻性选取2020年1月至2023年8月安康市人民医院收治的108例卵巢囊肿患者，采用随机数字表法分为对照组和研究组，每组54例。对照组年龄（49.85±5.68）岁，体质量指数（23.01±1.59）kg/m²，病程（4.62±0.71）年，美国麻醉医师协会（ASA）Ⅰ级20例，Ⅱ级34例；研究组年龄（51.05±6.23）岁，体质量指数（23.18±1.47）kg/m²，病程（4.79±0.76）年，ASA Ⅰ级18例，Ⅱ级36例。对照组给予咪达唑仑复合腰硬联合麻醉，研究组给予右美托咪定复合腰硬联合麻醉。对比两组围手术期血流动力学、术中寒颤、疼痛、认知功能、应激反应、炎症反应及不良反应情况。采用t检验、LSD-t检验和χ²检验进行统计比较。结果　麻醉诱导前（T0）、切皮时（T1）、麻醉30 min（T2）、术毕（T3）时，研究组平均动脉压分别为（93.02±5.97）mmHg（1 mmHg=0.133 kPa）、（81.03±4.86）mmHg、（84.51±6.24）mmHg、（86.12±4.05）mmHg，心率分别为（83.73±5.16）次/min、（68.76±4.16）次/min、（74.31±4.13）次/min、（76.02±4.84）次/min；对照组分别为（94.16±6.08）mmHg、（84.58±5.12）mmHg、（83.67±5.73）mmHg、（89.73±4.14）mmHg，（84.59±5.01）次/min、（72.32±4.85）次/min、（76.85±4.26）次/min、（79.88±5.01）次/min；两组不同时间点间的平均动脉压、心率差异均有统计学意义（F=9.143、8.769，均P<0.001），两组平均动脉压、心率差异均有统计学意义（F=8.371、8.416，均P<0.001），两组平均动脉压、心率变化趋势差异均有统计学意义（F=9.168、9.316，均P<0.001）。研究组寒颤发生率（5.56%，3/54）低于对照组（18.52%，10/54）（χ²=4.285，P=0.038）。术后4 h、12 h、24 h研究组疼痛视觉模拟量表（VAS）评分分别为（2.17±0.36）分、（3.07±0.38）分、（2.45±0.41）分，对照组分别为（2.21±0.39）分、（3.38±0.42）分、（2.69±0.43）分；不同时间点间的VAS评分差异有统计学意义（F=9.054，P<0.001），两组VAS评分差异有统计学意义（F=8.031，P<0.001），两组VAS评分变化趋势差异有统计学意义（F=7.968，P<0.001）。两组术前与术后12 h、24 h不同时间点简易精神状态检查量表（MMSE）评分、两组MMSE评分、两组MMSE评分变化趋势比较差异均无统计学意义（均P>0.05）。术后24 h研究组的肾上腺素、皮质醇、活性氧簇分别为（112.35±15.71）ng/L、（298.47±40.12）nmol/L、（115.71±12.89）mmol/L，对照组分别为（126.54±18.67）ng/L、（321.54±45.13）nmol/L、（127.54±15.32）mmol/L，均高于术前，且研究组均低于对照组（t=4.274、P<0.001；t=2.807、P=0.006；t=4.342、P<0.001）。术后24 h研究组的白细胞介素（IL）-6、IL-21、高迁移率族蛋白B1（HMGB1）分别为（40.02±4.93）ng/L、（9.02±1.51）ng/L、（42.76±5.01）ng/L，对照组分别为（43.98±5.27）ng/L、（10.17±1.69）ng/L、（46.89±5.84）ng/L，均高于术前，且研究组IL-6、IL-21、HMGB1均低于对照组（t=4.032、3.729、3.944，均P<0.001）。两组总不良反应发生率比较差异无统计学意义（χ²=0.375，P=0.540）。结论　右美托咪定复合腰硬联合麻醉用于腹腔镜卵巢囊肿切除术麻醉效果显著，有助于维持患者围手术期血流动力学稳定，并可降低术中寒颤发生风险，减轻患者围手术期疼痛，减轻围手术期应激反应及炎症反应，且不影响患者认知功能，安全可靠。

关键词:

右美托咪定, 腰硬联合麻醉, 腹腔镜, 卵巢囊肿手术, 效果

Wang Jun, Liao Weiyu, Wang Xiaoxu, Zhao Qibing.

Effect of dexmedetomidine combined with spinal-epidural anesthesia on laparoscopic ovarian cyst surgery [J]. International Medicine and Health Guidance News, 2024, 30(7): 1104-1110.

王军廖伟芋王晓旭赵启兵.

右美托咪定复合腰硬联合麻醉对腹腔镜卵巢囊肿手术的影响 [J]. 国际医药卫生导报, 2024, 30(7): 1104-1110.

References

[1] Shi X, Chen S, Yang Y, et al. Laparoscopic surgeries for uterine fibroids and ovarian cysts reduce ovarian reserve via age- and surgical type-manner[J]. Gynecol Endocrinol, 2022,38(12):1068-1072. DOI: 10.1080/09513590.2022.2128104.
[2] Kinay T, Kizilkaya Y, Altinbas SK, et al. Feasibility and safety of laparoscopic surgery in large ovarian masses[J]. Gynecol Minim Invasive Ther, 2022,11(4):215-220. DOI: 10.4103/gmit.gmit_122_21.
[3] Shi J, An D, Ye J, et al. Effect of early inflammatory reaction on ovarian reserve after laparoscopic cystectomy for ovarian endometriomas[J]. J Obstet Gynaecol, 2022,42(7):3124-3128. DOI: 10.1080/01443615.2022.2106559.
[4] Romeo L, Bagolini F, Ferro S, et al. Laparoscopic surgery for splenic injuries in the era of non-operative management: current status and future perspectives[J]. Surg Today, 2021,51(7):1075-1084. DOI: 10.1007/s00595-020-02177-2.
[5] Ponferrada AR, Romero Molina S, Ruiz JCM, et al. Anesthesia and cancer: something more than avoiding stress response[J]. Curr Gene Ther, 2023,23(4):261-275. DOI: 10.2174/1566523223666230328165109.
[6] Major AL, Jumaniyazov K, Yusupova S, et al. Removal of a giant cyst of the left ovary from a pregnant woman in the first trimester by laparoscopic surgery under spinal anesthesia during the COVID-19 pandemic[J]. Med Sci (Basel), 2021,9(4):70. DOI: 10.3390/medsci9040070.
[7] Shlobin NA, Rosenow JM. Nonopioid postoperative pain management in neurosurgery[J]. Neurosurg Clin N Am, 2022,33(3):261-273. DOI: 10.1016/j.nec.2022.02.004.
[8] Jeong A, Wade K. Dexamethasone prescribing for cancer pain between palliative care and radiation oncology[J]. Support Care Cancer, 2022,30(9):7689-7696. DOI: 10.1007/s00520-022-07203-2.
[9] Short TG, Campbell D, Frampton C, et al. Anaesthetic depth and complications after major surgery: an international, randomised controlled trial[J]. Lancet, 2019,394(10212):1907-1914. DOI: 10.1016/S0140-6736(19)32315-3.
[10] He S, Renne A, Argandykov D, et al. Comparison of an emoji-based visual analog scale with a numeric rating scale for pain assessment[J]. JAMA, 2022,328(2):208-209. DOI: 10.1001/jama.2022.7489.
[11] Pinto TCC, Machado L, Bulgacov TM, et al. Is the Montreal Cognitive Assessment (MoCA) screening superior to the Mini-Mental State Examination (MMSE) in the detection of mild cognitive impairment (MCI) and Alzheimer's Disease (AD) in the elderly?[J]. Int Psychogeriatr, 2019,31(4):491-504. DOI: 10.1017/S1041610218001370.
[12] Kawka M, Fong Y, Gall TMH. Laparoscopic versus robotic abdominal and pelvic surgery: a systematic review of randomised controlled trials[J]. Surg Endosc, 2023,37(9):6672-6681. DOI: 10.1007/s00464-023-10275-8.
[13] Shaltout MF, Maged AM, Abdella R, et al. Laparoscopic guided minilaparotomy: a modified technique for management of benign large ovarian cysts[J]. BMC Womens Health, 2022,22(1):269. DOI: 10.1186/s12905-022-01853-4.
[14] Soltan WA, Fathy E, Khattab M, et al. Combined thoracic spinal-epidural anesthesia for laparoscopic sleeve gastrectomy; one hundred case experience[J]. Obes Surg, 2022,32(2):457-462. DOI: 10.1007/s11695-021-05796-x.
[15] McDonald D, Palsgraf H, Shah P. Dexmedetomidine - an emerging option for sedation in neonatal patients[J]. J Perinatol, 2022,42(7):845-855. DOI: 10.1038/s41372-022-01351-3.
[16] Karthik NM, Das SG, Johney J, et al. Comparison of postoperative analgesia with two different doses of dexmedetomidine as an adjuvant to ropivacaine in adductor canal block for unilateral total knee replacement surgery: a randomized double-blinded study[J]. J Anaesthesiol Clin Pharmacol, 2022,38(3):428-433. DOI: 10.4103/joacp.JOACP_493_20.
[17] Møller MH, Alhazzani W, Lewis K, et al. Use of dexmedetomidine for sedation in mechanically ventilated adult ICU patients: a rapid practice guideline[J]. Intensive Care Med, 2022,48(7):801-810. DOI: 10.1007/s00134-022-06660-x.
[18] Thomas A, Ullrich M. Dexmedetomidine: a sedation alternative in the intensive care setting[J]. Crit Care Nurs Q, 2023,46(3):271-276. DOI: 10.1097/CNQ. 0000000000000458.
[19] 王静. 右美托咪定对腹腔镜子宫肌瘤剔除术患者镇痛效果及认知功能的影响[J]. 中国内镜杂志,2022,28(11):15-20. DOI:10.12235/E20220029.
[20] Cai X, Gao R, Wang R, et al. Dexmedetomidine and lidocaine: useful adjuvants for analgesia after abdominal surgery?[J]. Pain Physician, 2022,25(2):E399-E401.
[21] 刘宁,徐四七,居霞,等. 右美托咪定复合利多卡因不同停药时间对妇科腹腔镜术后氧化应激、炎症因子及苏醒质量的影响[J]. 中国实验诊断学,2022,26(12):1749-1754. DOI:10.3969/j.issn.1007-4287.2022.12.003.
[22] Weng J, Cheng Z, Li S. Effects of dexmedetomidine on surgical site wound pain in patients undergoing laparoscopic cholecystectomy: a meta-analysis[J]. Int Wound J, 2023,20(9):3657-3664. DOI: 10.1111/iwj.14256.
[23] Wang W, Ma Y, Liu Y, et al. Effects of dexmedetomidine anesthesia on early postoperative cognitive dysfunction in elderly patients[J]. ACS Chem Neurosci, 2022,13(15):2309-2314. DOI: 10.1021/acschemneuro.2c00173.