1. Department of Anesthesiology, Fujian Provincial Hospital South Branch, Fujian Province, Fuzhou 350028, China;
2. Department of Healthcare, the Fifth Affiliated Hospital of Sun Yat-sen Univesity, Guangdong Province, Zhuhai 519000, China;
3. Department of Gastroenterology, Fujian Provincial Hospital, Fujian Province, Fuzhou 350001, China;
4. Department of Gastroenterology, Fujian Provincial Hospital South Branch, Fujian Province, Fuzhou 350028, China
Abstract：Objective To compare the efficacy of Dexmedetomidine and Remifentanil combined with Sevoflurane in endoscopic retrograde cholangiography (ERCP). Methods A total of 80 elective ERCP patients admitted to Fujian Provincial Hospital South Branch from March 2019 to February 2020 were selected as the study subjects, and divided into Dexmedetomidine (DEX) group (40 cases) and Remifentanil (REMI) group (40 cases) according to computer random number method.In DEX group,DEX 0.8 μg/kg was pumped 10 min before induction of anesthesia,DEX 0.2 g/(kg·h) was maintained during surgery,and pumping was stopped 10 min before the end of surgery.In the REMI group, 2.5 μg/(kg·h)REMI was pumped from 10 min before induction of anesthesia to the end of surgery. Postoperative pain intensity, postoperative analgesia needs, incidence of adverse reactions, postoperative recovery, extubation time, anesthesia time and Sevoflurane usage were compared between the two groups. The hemodynamic change of two groups were compared before drug pumping (T0), 10 min after drug pumping (T1), immediately after endotracheal intubation (T2), 1 min after intubation (T3), immediately after operation (T4), 15 min after operation (T5), when entering the post-anesthesia monitoring treatment room (T6), immediately after extubation (T7), 1 min after extubation (T8). Results There were no significant differences in postoperative pain intensity, analgesic need, incidence of adverse reactions, postoperative awakening, extubation time and anesthesia time between two groups (P＞0.05). The Sevoflurane dose and dose per unit time in DEX group were lower than those in REMI group, and the differences were statistically significant (P＜0.05). In terms of hemodynamic changes, blood pressure at T3 and T4 in DEX group was lower than that in REMI group, heart rate at T2-T8 in DEX group was lower than that in REMI group, and the differences were statistically significant (P＜0.05). There were no significant differences in blood pressure and heart rate between the two groups at other time points (P＞0.05). Conclusion Low-dose Dexmedetomidine is used for ERCP treatment and is equivalent to Remifentanil. However, Dexmedetomidine can reduce intraoperative stress induced hemodynamic fluctuations and the need for inhalation anesthesia, and can be safely used as an alternative adjuvant to Remifentanil.
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