Discussion
bradycardia, sleep disorders, sleep disturbance, blood loss, ±, BP reduction, traumatic, hypotension, postoperative sore throat
BLOOD LOSS, COMPLICATION
Maxillofacial plastic surgery changes the contour of the face by modifying the bone structure of the maxillofacial region. The procedure is long and traumatic and requires general anesthesia and controlled BP reduction to reduce blood loss during the operation. Postoperative pressure bandaging is required, and there is excessive oral secretion [In this study, 1.0 and 1.5 μg/kg dexmedetomidine stock solution atomized nasal sprays were used to treat sleep disturbance on the night after operation in participants having undergone maxillofacial surgery. The results showed that dexmedetomidine nasal sprays at both concentrations could effectively prolong N2 sleep (BC, 1.0 Dex, 1.5 Dex: 181.4 ± 72.2, 240.7 ± 89.4, 259.4 ± 71.5 min), shorten the waking time, reduce the number of awakenings from sleep, significantly improve sleep efficiency, reduce PSQI score, and reduce the incidence of sleep disorders. Notably, 1.5 μg/kg dexmedetomidine nasal spray could also effectively prolong N3 sleep. In addition, 1.5 μg/kg dexmedetomidine nasal spray could also reduce the number of times sufentanil rescue had to be used postoperatively; furthermore, it reduced the incidence of postoperative sore throat and the length of hospital stay. Wu XH, et al. founded that dexmedetomidine infusion increased the percentage of stage N2 sleep from 15.8% with placebo to 43.5% with dexmedetomidine; it also prolonged the total sleep time, decreased the percentage of stage N1 sleep, increased the sleep efficiency, and improved the subjective sleep quality. Dexmedetomidine increased the incidence of hypotension without significant intervention [Sleep includes REM sleep and non-rapid eye movement (NREM) sleep. NREM sleep is subdivided into N1, N2, and N3 sleep, representing progressively deeper stages of sleep. In this study, using PSG, we could objectively analyze sleep staging by studying EEG, EMG, and electrooculography findings [Dexmedetomidine is convenient to administer via a nasal spray, which supports rapid onset of action. Intranasal bioavailability was estimated to be 40.6% and 40.7% for atomisation and drops respectively. Degree and duration of sedation were similar for i.v. and intranasal administration [This study selected patients who underwent maxillofacial surgery in the morning. When dexmedetomidine was postoperatively administered via a nasal spray, the anesthesia withdrawal time was more than 4 h. After the operation, additional sedative and analgesic drugs were used according to the patient’s voluntary requirements. A common complication of dexmedetomidine is slow HR. In this study, bradycardia occurred in 8, 14, and 18 patients in the BC group, 1.0 μg/kg Dex group, and 1.5 μg/kg Dex group on the night after the operation, respectively; however, the HR did not reduce beyond 50 beats/min in any of the patients, related to sleep state. Although the HR decreased during sleep, no heart rate-increasing medication was administered.