Study on the median effective dose of dezocine to inhibit the response to modified nasopharyngeal airway insertion during hysteroscopic surgery in elderly female patients when combined with remimazolam

Bao Yin; Wang Guyan; Zhang Congya; Wang Ying; Li Kaibo; Wang Huijun

doi:10.3760/j.issn.1673-4777.2025.02.019

Abstract：Objective To investigate the median effective dose(ED50)of dezocine to inhibit the response to modified nasopharyngeal airway insertion during hysteroscopic surgery in elderly female patients when combined with remimazolam.Methods Twenty-eight patients,aged 60-75 years,American Society of Anesthesiologists grade Ⅱ-Ⅲ,scheduled for elective hysteroscopic surgery in Beijing Tongren Hospital,Capital Medical University from February to April 2024,were selected.Dezocine 0.15 mg/kg was injected,and 10 minutes later atropine 0.3 mg,dexamethasone 5 mg and remimazolam 0.3 mg/kg were injected intravenously.When the eyelash reflex disappeared and the patient's state index was less than 50,a fully lubricated modified nasopharyngeal airway was inserted through the nasal cavity.The dose of dezocine in the next patient was determined by sequential method.If there was a positive reaction when the nasopharyngeal airway was inserted,the dose of dezocine in the next patient was increased by 0.01 mg/kg,otherwise the dose of dezocine was decreased by 0.01 mg/kg.The first patient with a positive nasopharyngeal airway reaction was considered the first patient to enter the trial,and this process was repeated until seven turning points had been reached.The ED50 and 95％confidence interval of dezocine inhibiting response to modified nasopharyngeal airway insertion in elderly patients were calculated when combined with remimazolam.The occurrence of adverse reactions during induction was recorded.Results One patient was excluded from this study because of poor ventilation after insertion of the nasopharyngeal airway,which was changed to laryngeal mask airway during the operation.The remaining 27 patients completed the trial,and the ED50(95％confidence interval)of dezocine inhibiting response to modified nasopharyngeal airway insertion was 0.105(0.087-0.114)mg/kg when combined with remimazolam.No adverse reactions such as nasopharyngeal pain,hypoxemia,drowsiness,nausea and vomiting,and respiratory depression occurred in the enrolled patients.One patient had transient dizziness after extubation and recovered after full recovery in the recovery room.Conclusion When combined with 0.3 mg/kg remimazolam,the ED50(95％confidence interval)of dezocine inhibiting the modified nasopharyngeal airway insertion response is 0.105(0.087-0.114)mg/kg in elderly female patients during hysteroscopic surgery.