Application of Dexmedetomidine in Combined Spinal Epidural Anesthesia for Laparoscopic Total Extraperitoneal Hernia Repair_West China Medical Journal

Authors：

 HanXiwen , LiKaiyan , LiJinying

Department of Anesthesiology, Jiaozhou Central Hospital of Qingdao City, Jiaozhou, Shandong 266300, P. R. China;

Corresponding?author：

Keywords：

Dexmedetomidine; Combined spinal epidural anesthesia; Laparoscopy; Hernia repair

DOI：

10.7507/1002-0179.201600133

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Objective To observe the effects and security of dexmedetomidine in combined spinal epidural anesthesia (CSEA) for laparoscopic total extraperitoneal hernia repair (TEP). Methods From January 2010 to January 2013, we selected 90 patients who were going to receive TEP surgery as our study subjects. The patients were divided into three groups:M1, M2 and M3 with 30 patients in each. The patients had left lateral position, and anesthesia was done between 3-4 lumbar epidural line. Injection of 0.5% bupivacaine 2 mL was carried out, and epidural catheter was 3-5 cm. Anesthesia plane was adjusted from the chest 4 or 6 vertebra to the sacral vertebra. The three groups of patients were treated with micro pump using dexmedetomidine given at a pre-charge of 0.5 μg/kg, and then group M1 was maintained by 0.3 μg/(kg·h), M2 by 0.5 μg/(kg·h), and M3 by 0.7 μg/(kg·h). The changes of mean arterial pressure (MAP), heart rate, respiration and pulse oximetry (SpO₂) were observed at each time point, and bispectral index (BIS) monitor and Ramsay sedation score test were also conducted. Results The changes of MAP, heart rate and respiration in group M1 were not obvious; the Ramsay score for group M1 was 2 to 3, and BIS value after pre-charge was 65-84. For group M2, MAP, heart rate and respiration had a slight decline; Ramsay score was 3-5 points, and BIS value was 60-79. In group M3, patients had a milder decline in their MAP and respiration; the heart rate declined obviously after receiving dexmedetomidine and one patient with severe decline of the heart rate alleviated after active treatment; Ramsay score was 5 to 6 points, and BIS value was between 55 and 75. There was little change in SpO₂ in all the three groups, and the difference was not statistically significant (P>0.05). Conclusion Continuous injection of dexmedetomidine at 0.3-0.5 μg/(kg·h) in CSEA is an alternative way for anesthesia, which can effectively promote sedation and reduce pain and discomfort.

Citation： HanXiwen, LiKaiyan, LiJinying. Application of Dexmedetomidine in Combined Spinal Epidural Anesthesia for Laparoscopic Total Extraperitoneal Hernia Repair. West China Medical Journal, 2016, 31(3): 503-506. doi: 10.7507/1002-0179.201600133 Copy

1.	姚琪遠. 腹腔鏡疝修補手術常見并發癥及處理[J]. 中國實用外科雜志, 2007, 27(9):708-710.
2.	劉忠誠, 徐建, 張晨輝. 硬膜外麻醉聯合腰麻腹腔鏡下完全腹膜外疝修補治療腹股溝斜疝15例體會[J]. 腹腔鏡外科雜志, 2007, 12(1):20-21.
3.	趙俊杰, 趙俊. 現代麻醉學[M]. 北京:人民衛生出版社, 1987:798-799.
4.	羅遠國, 李洪, 曹國輝, 等. 異丙酚復合腰硬聯合麻醉對婦科腹腔鏡手術患者氧代謝的影響[J]. 廣西醫學, 2007, 29(5):630-633.
5.	劉玲, 紀風濤, 劉付寧, 等. 右美托咪定對老年患者腰-硬聯合麻醉的鎮靜效應[J]. 臨床麻醉學雜志, 2011, 27(1):49-51.
6.	Murrell JC, Hellebrekers LJ. Medetomidine and dexmedetomidine:a review of cardiovascular effects and antinociceptive properties in the dog[J]. Vet Anaesth Analg, 2005, 32(3):117-127.
7.	Ebert TJ, Hall JE, Barney JA, et al. The effects of increasing plasma concentrations of dexmedetomidine in humans[J]. Anesthesiology, 2000, 93(2):382-394.
8.	易利丹, 彭六保, 譚重慶, 等. 新型鎮靜鎮痛藥——右美托咪定[J]. 中國新藥與臨床雜志, 2011, 1(1):5-10.
9.	李俊明, 李麗. 右美托咪定對老年患者腰硬聯合麻醉的鎮靜效應[J]. 齊齊哈爾醫學院學報, 2014, 35(1):67-68.
10.	Talke P, Lobo E, Brown R. Systemically administered alpha2-agonist-induced peripheral vasoconstriction in humans[J]. Anesthesiology, 2003, 99(1):65-70.
11.	Mack PF, Perrine K, Kobylarz E, et al. Dexmedetomidine and neurocognitive testing in awake craniotomy[J]. J Neurosurg Anesthesiol, 2004, 16(1):20-25.
12.	陳龍, 張茂銀, 耿興云. 兩種麻醉方法對老年老年胸科手術患者血液流變學的影響[J]. 中華老年醫學雜志, 2007, 26(4):278-281.
13.	李彥文, 歐陽文, 汪賽贏, 等. 不同劑量右旋美托咪啶的鎮靜效應[J]. 臨床麻醉學雜志, 2010, 26(7):580-582.
14.	Koroglu A, Teksan H, Sagir O, et al. A comparison of the sedative, hemodynamic, and respiratory effects of dexmedetomidine and propofol in children undergoing magnetic resonance imaging[J]. Anesth Analg, 2006, 103(1):63-67, table of contents.
15.	陳仲群, 郭緒鏗. 右美托咪定在硬膜外麻醉術中的鎮靜作用[J]. 廣東醫學, 2011, 32(12):1614-1615.

1. 姚琪遠. 腹腔鏡疝修補手術常見并發癥及處理[J]. 中國實用外科雜志, 2007, 27(9):708-710.
2. 劉忠誠, 徐建, 張晨輝. 硬膜外麻醉聯合腰麻腹腔鏡下完全腹膜外疝修補治療腹股溝斜疝15例體會[J]. 腹腔鏡外科雜志, 2007, 12(1):20-21.
3. 趙俊杰, 趙俊. 現代麻醉學[M]. 北京:人民衛生出版社, 1987:798-799.
4. 羅遠國, 李洪, 曹國輝, 等. 異丙酚復合腰硬聯合麻醉對婦科腹腔鏡手術患者氧代謝的影響[J]. 廣西醫學, 2007, 29(5):630-633.
5. 劉玲, 紀風濤, 劉付寧, 等. 右美托咪定對老年患者腰-硬聯合麻醉的鎮靜效應[J]. 臨床麻醉學雜志, 2011, 27(1):49-51.
6. Murrell JC, Hellebrekers LJ. Medetomidine and dexmedetomidine:a review of cardiovascular effects and antinociceptive properties in the dog[J]. Vet Anaesth Analg, 2005, 32(3):117-127.
7. Ebert TJ, Hall JE, Barney JA, et al. The effects of increasing plasma concentrations of dexmedetomidine in humans[J]. Anesthesiology, 2000, 93(2):382-394.
8. 易利丹, 彭六保, 譚重慶, 等. 新型鎮靜鎮痛藥——右美托咪定[J]. 中國新藥與臨床雜志, 2011, 1(1):5-10.
9. 李俊明, 李麗. 右美托咪定對老年患者腰硬聯合麻醉的鎮靜效應[J]. 齊齊哈爾醫學院學報, 2014, 35(1):67-68.
10. Talke P, Lobo E, Brown R. Systemically administered alpha2-agonist-induced peripheral vasoconstriction in humans[J]. Anesthesiology, 2003, 99(1):65-70.
11. Mack PF, Perrine K, Kobylarz E, et al. Dexmedetomidine and neurocognitive testing in awake craniotomy[J]. J Neurosurg Anesthesiol, 2004, 16(1):20-25.
12. 陳龍, 張茂銀, 耿興云. 兩種麻醉方法對老年老年胸科手術患者血液流變學的影響[J]. 中華老年醫學雜志, 2007, 26(4):278-281.
13. 李彥文, 歐陽文, 汪賽贏, 等. 不同劑量右旋美托咪啶的鎮靜效應[J]. 臨床麻醉學雜志, 2010, 26(7):580-582.
14. Koroglu A, Teksan H, Sagir O, et al. A comparison of the sedative, hemodynamic, and respiratory effects of dexmedetomidine and propofol in children undergoing magnetic resonance imaging[J]. Anesth Analg, 2006, 103(1):63-67, table of contents.
15. 陳仲群, 郭緒鏗. 右美托咪定在硬膜外麻醉術中的鎮靜作用[J]. 廣東醫學, 2011, 32(12):1614-1615.

West China Medical Journal

Application of Dexmedetomidine in Combined Spinal Epidural Anesthesia for Laparoscopic Total Extraperitoneal Hernia Repair

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