Introduction
Patients receiving hysteroscopic and laparoscopic
surgery commonly experience severe pain during surgery. In
addition, there is a relatively great impact on the nervous system
at the same time (1,2). As an anesthetic adjuvant drug,
dexmedetomidine has a good sedative effect in surgery. Also,
dexmedetomidine is an adrenergic receptor agonist with good
efficacy on sedation, anti-anxiety and neuroprotection (3–5).
In this study, patients receiving hysteroscopic and
laparoscopic surgery in our hospital were selected and given
different doses of dexmedetomidine, respectively, to explore the
anesthetic effects of the drug in the process of surgery and
determine the optimal dose for achieving the best efficacy.
Patients and methods
Objects of study
A total of 179 patients who received laparoscopic
surgery in The First People's Hospital of Wujiang District (Suzhou,
China) from March 2015 to May 2017 were selected and randomly
divided into the control group and three groups with different
doses of dexmedetomidine. Among them, the control group (group A)
included 42 patients aged 23–43 years, with an average age of
34.4±7.3 years; the low-dose group (group B) included 47 patients,
aged 22–44 years, with a mean age of 35.4±6.8 years; the
middle-dose group (group C) had 45 patients, aged 22–45 years, with
a mean age of 34.9±6.4 years; and the high-dose group (group D) had
45 patients, aged 23–44 years, with a mean age of 36.9±6.8 years.
There were no significant differences in age and pathogenetic
condition of the patients among the four groups (p>0.05), and
the data were comparable. All patients were aware of the clinical
protocol before the study and signed the informed consent. This
study was approved by the Ethics Committee of The First People's
Hospital of Wujiang District (Suzhou, China). Inclusion criteria
were: female patients aged 20–45 years and rated as class 1 based
on the America society of Anesthesiologist (ASA) classification.
Exclusion criteria were: patients with mental disease or with
injury in the heart, liver, kidney and other vital organs.
Methods
The four groups of patients received anesthesia
induction, in which, the medication dosages were 0.6
mg·kg−1, 2 mg·kg−1 and 2 µg·kg−1
for rocuronium bromide, propofol and fentanyl, respectively, and
tracheal intubation was also performed. Patients in groups B, C and
D were given 0.25, 0.5 and 1 µg/kg dexmedetomidine, respectively,
while those in group A were administered with the same dose of 0.9%
NaCl solution. Patients in each group received intravenous infusion
for 10 min. After incubation, mechanical ventilation was carried
out with tidal volume set at 8 ml/kg and respiratory rate at 8
breaths per minute. During surgery, doses of propofol and fentanyl
were adjusted according to the patient's condition. When the
endoscope was withdrawn, medication was stopped immediately.
Observation indicators and efficacy
evaluation
The operation duration, intraoperative bleeding
volume and intraoperative transfusion volume of each patient were
recorded. Serum inflammatory cytokines [C-reactive protein (CRP),
tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10)] of
patients were detected. Visual analogue scale (VAS) scoring.
Agitation scoring and Sedation scoring were also recorded for each
patient (6–10).
Statistical analysis
SPSS 19.0 software (IBM, Armonk, NY, USA) was used
for statistical analysis. All quantitative data were expressed as
mean ± standard deviation (SD). Comparison between groups was done
using one-way ANOVA test followed by post hoc test (Least
Significant Difference). P-values <0.05 were considered
statistically significant.
Results
Surgical situations of patients in
four groups
The operation duration, intraoperative bleeding
volume and intraoperative transfusion volume of the four groups of
patients showed no differences (p>0.05) (Table I).
 | Table I.Surgical situations of patients in
four groups (mean ± SD). |
Table I.
Surgical situations of patients in
four groups (mean ± SD).
| Group | n | Operation duration
(min) | Intraoperative
bleeding volume (ml) | Intraoperative
transfusion volume (ml) |
|---|
| A | 42 |
181.2±4.5a |
109.3±5.2a |
2,299±102.3a |
| B | 47 | 179.5±6.4 | 110.2±6.3 | 2,208±130.4 |
| C | 45 | 180.9±7.3 | 108.9±4.8 | 2,219±128.6 |
| D | 45 | 180.1±6.9 | 109.4±5.8 | 2,297±185.8 |
Postoperative VAS scores of patients
in four groups
It was found that the VAS scores at all time-points
in the control group were significantly higher than those in the
other three treatment groups after operation, and the scores in
group D were the lowest (Table
II).
| Table II.VAS scores of patients in four groups
after operation (mean ± SD). |
Table II.
VAS scores of patients in four groups
after operation (mean ± SD).
|
| Time (h) |
|---|
|
|
|
|---|
| Group | 2 | 4 | 12 | 24 |
|---|
| A | 4.2±0.9a | 2.9±0.3a | 2.4±0.3a | 1.4±0.2a |
| B | 2.9±0.4 | 2.1±0.2 | 1.7±0.2 | 0.9±0.1 |
| C | 2.7±0.3 | 2.0±0.2 | 1.6±0.1 | 0.7±0.1 |
| D | 2.4±0.2 | 1.9±0.1 | 1.3±0.2 | 0.6±0.1 |
Comparison of agitation score and
sedation score in patients among four groups
In comparison with group A, group C had obviously
decreased agitation score and sedation score (p<0.05); there
were no evident differences in agitation score and sedation score
between groups A and B; sedation score in group D was clearly
higher than that in group C (Table
III).
| Table III.Comparison of agitation score and
sedation score in patients among four groups (mean ± SD). |
Table III.
Comparison of agitation score and
sedation score in patients among four groups (mean ± SD).
| Group | Agitation score | Sedation score |
|---|
| A | 2.7±0.2 | 1.1±0.1 |
| B | 2.2±0.2 | 1.1±0.1 |
| C | 1.2±0.1a | 1.9±0.2a |
| D | 2.2±0.1 | 5.5±0.2a,b |
Comparison of serum inflammatory
cytokines in patients among the four groups
The levels of CRP, TNF-α and IL-10 in groups A, B
and C were significantly increased at T2, T3 and T4, while the
levels of IL-10 at T2, T3 and T4 in group D were overtly higher
than that at T1 (p<0.05), while the levels of inflammatory
cytokines in groups A and B had no significant differences. In
addition, the levels of CRP and TNF-α in patients in groups A and B
were clearly higher than those in groups C and D, while the
increases in levels of IL-10 in groups C and D were significantly
higher than those in the first two groups (p<0.05) (Table IV).
| Table IV.Comparison of serum inflammatory
cytokines in patients among four groups (mean ± SD). |
Table IV.
Comparison of serum inflammatory
cytokines in patients among four groups (mean ± SD).
| Group | Time | CRP (mg/l) | TNF-α (ng/l) | IL-10 (ng/l) |
|---|
| A | T1 |
11.45±2.12a | 19.25±3.32 | 12.57±1.78 |
|
| T2 | 36.71±6.32 | 32.45±6.43 | 16.79±1.98 |
|
| T3 | 64.98±4.75 | 56.39±6.43 | 18.69±2.09 |
|
| T4 | 44.62±4.53 | 46.21±6.78 | 19.79±2.34 |
| B | T1 |
11.50±1.64a | 18.29±3.45 | 12.10±2.12 |
|
| T2 | 34.26±7.43 | 31.20±6.43 | 12.21±1.97 |
|
| T3 | 64.98±7.54 | 53.96±4.77 | 16.92±2.32 |
|
| T4 | 43.21±6.78 | 44.05±4.56 | 19.41±1.98 |
| C | T1 |
11.27±2.43a | 18.56±2.43 | 12.31±1.02 |
|
| T2 |
24.07±3.43b |
24.15±3.45b | 21.09±2.98 |
|
| T3 |
43.52±4.32b |
36.21±3.75b |
24.69±2.0b |
|
| T4 |
33.21±3.86b |
28.42±4.32b |
25.76±2.21b |
| D | T1 | 11.72±2.43 | 18.26±4.21 |
12.09±1.09a |
|
| T2 |
16.21±4.54b |
19.45±2.11b | 23.21±2.02 |
|
| T3 |
18.21±4.52b |
22.45±2.31b |
25.76±2.01b |
|
| T4 |
16.52±3.87b |
21.69±2.67b |
24.5±62.78b |
Comparison of adverse reactions in
patients among four groups
Adverse reactions of patients in the four groups
were compared, and it was found that group C had significantly
fewer cases in tachycardia, bradycardia and hypertension compared
with those in groups A and B. Finally, patients in group D had
symptoms of bradycardia and hypotension, and sometimes hypertension
and delayed recovery (Table V).
| Table V.Comparisons of adverse reactions in
patients among four groups (n). |
Table V.
Comparisons of adverse reactions in
patients among four groups (n).
| Adverse
reaction | A | B | C | D |
|---|
| Tachycardia | 9 | 7 | 0a | 0 |
| Bradycardia | 7 | 7 | 0a | 5 |
| Hypertension | 7 | 2 | 1a | 2 |
| Hypotension | 2 | 0 | 1 | 4 |
| Nausea and
vomiting | 0 | 1 | 0 | 0 |
| Respiratory
depression | 1 | 1 | 0 | 0 |
| Delayed
recovery | 1 | 0 | 0 | 1 |
Discussion
With the development of medical devices,
hysteroscope combined with laparoscope has been applied in a
variety of gynecological diseases, such as uterine fibroids and
uterus septum, and the use can improve the accuracy of diagnosis
and cure rate, with an easy operation (11). However, during the operation, the
patient may have pain and have adverse reaction effects on
inflammation and nerves at the same time. Therefore, the
application of an effective anesthetic method is especially
important. The use of an appropriate dose of anesthetic in the
operation can relieve the pain of the patient, and is also able to
reduce the damage to the patient tissue (12,13).
Among anesthetics, dexmedetomidine is an adrenergic
receptor agonist, which is widely used in anesthesiology. It
suppresses the central and sympathetic nerves so as to reduce the
tension on the sympathetic nerve and increase the activity of vagas
nerve, thereby lowering the release of noradrenaline in the body
and achieving the sedation effect on the patient (14,15).
Important factors for the assessment of inflammation
are CRP, TNF-α and IL-10. A stress response in the body can
stimulate the secretion of CRP (an acute phase protein). A trauma
or an infection of the body is sure to result in a sharp increase
in TNF-α, and hypersecretion of this factor can trigger an
inflammatory response (16).
However, IL-10 inhibits TNF-α in the body. Therefore, its increased
secretion will relieve the inflammatory condition when inflammation
occurs (17–20).
In this study, it was found that the cellular
inflammatory cytokines CRP and TNF-α in dexmedetomidine groups were
significantly lower than those in the control group, and IL-10 in
groups C and D were overtly higher than those in the other two
groups, indicating that the use of dexmedetomidine is able to
relieve the body's inflammation and protect it from invasion of
pathogens. The agitation, sedation and VAS scoring carried out on
patients revealed that the control group had increased agitation
and VAS scores in comparison with dexmedetomidine groups, and
reduced sedation score compared with those in groups C and D. Among
the three dexmedetomidine groups, the situation of agitation and
sedation of patients were the best in group C, so the dose of 0.5
µg/kg was the optimal dose. It was also found that the number of
patients with adverse reactions was the minimum in group C and
significantly lower than those in groups A and B, and there was a
greater number of cases with symptoms of bradycardia and
hypotension in group D, which also well proved that the dose of 0.5
µg/kg was the best choice. This study found that the patients in
the three dexmedetomidine groups had few effects on T-lymphocyte
subsets, which could ensure stable T-lymphocyte subsets in
patients.
In conclusion, the use of dexmedetomidine in
patients undergoing hysteroscopic surgery can relieve the patient's
pain, decrease the release of inflammatory cytokines in vivo
and protect cellular immunity. Dexmedetomidine has a high clinical
therapeutic value, which is worth promoting and applying in
clinical practice.
Acknowledgements
Not applicable.
Funding
No funding was received.
Availability of data and materials
All data generated or analyzed during this study are
included in this published article.
Authors' contributions
ZW and JW designed the study. HC and LW collected
the patient data. ZW and JW analyzed the patient data. All authors
have read and approved the final manuscript.
Ethics approval and consent to
participate
This study was approved by the Ethics Committee of
The First People's Hospital of Wujiang District (Suzhou, China).
All patients were aware of the clinical protocol before the study
and signed the informed consent.
Patient consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing
interests.
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