Analysis of the intraoperative sedative effect of dexmedetomidine and its impact on parturients and neonates for postoperative analgesia during cesarean section
ZHANG Min-yu,LI Qian,DONG Yan
Department of Anesthesiology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin300000, China
Abstract:
Objective To evaluate the effect of different doses of dexmedetomidine (Dex) on intraoperative sedation and combined with sufentanil on analgesia after cesarean section, then to observe the impact on maternal and infants. Methods Ninety monocyesis of American Society of Anesthesiologist physical status II, aged 18-45 year, scheduled for elective cesarean section under spinal anesthesia. They were divided into group D1, group D2, and group C randomly (30 patients in each group). Groups D1 and D2 were pumped load dose of Dex after delivery respectively (group D1 0.4 μg/kg, group D2 0.6 μg/kg), then maintained with Dex until the fat layer is closed [group D1 0.4 μg/(kg·h), group D2 0.6 μg/(kg·h)], group C was given the same amount of normal saline, all the puerperas were taken for controlled intravenous analgesia during the suture (group C was used sufentanil 100 μg, group D1 was used sufentanine 100 μg combined with Dex 150 μg, and group D2 was used sufentanil 100 μg combined with Dex 200 μg, 100 mL postoperative anglgesia pump). Record the blood pressure and heart rate of maternal, included T1 (baseline), T2 (after delivery), T3 (at the end of surgery), T4 (12 h after surgery), T5 (36 h after surgery), record Apgar score of neonatal (1 min and 5 min), 12 and 36 h of Neonatal Behavioral Neurological Assessment score (NBNA). The visual analogue scale (VAS) and observer's assessment of alterness score (OAA/S) were applied to evaluate pain degree and sedation scores (include the time of T3, T4, T5), record the rate of analgesic pump pressing frequently, the total sleep time of 36 h after surgery were recorded, meanwhile, mother's lactation andexhaust time were recorded too, the incidence of adverse reactions were also recorded, the 6-week postpartum depression score was recorded using the Edinburgh Postnatal Depression Scale (EPDS). Results Compared to group C, the rate of heart at T4 and T5 were lower in group D2 (P <0.05). The OAA/S scores in groups D1 and D2 at T3 and T4 were lower than those in group C (P <0.05). Patients in group study had a significantly lower VAS scores than control group, and that scores of group D2 was lower than group D1 (P <0.05). There was no statistical difference in NBNA scores among the three groups (P >0.05). The proportion of frequent postoperative analgesic pump presses in groups D1 and D2 was significantly lower than that in group C (P <0.05). Compared to the other groups, puerperas in group D2 had earlier first lactation and exhaust time, longer total sleep time, low EPDS score, and high maternal satisfaction (P <0.05). The incidence of nausea and vomiting was lower in Groups D1 and D2 than that in Group C (P <0.05), and the incidence of other adverse reactions was not significantly different among the three groups (P >0.05). Conclusion Dex can be safely used for sedation during spinal-epidural anesthesia, then provide satisfactory sedative effect. Dex 200 μg compound sufentanil 100 μg was used for postoperative analgesia after cesarean section, which can improve the analgesic effect, facilitate premature lactation and exhaust, increase sleep time, reduce the risk of postpartum depression, and improve the overall maternal satisfaction, and there were no bad effect of neonatal behavioral ability for infants.
