Effects of Dexmedetomidine and Propofol on Postoperative Analgesia and the Cellular Immune Function of Patients Undergoing Radical Gastrectomy for Gastric Cancer.

In order to optimize the anesthesia scheme and improve the effect of surgical treatment, the effects of dexmedetomidine and propofol on postoperative analgesia and cellular immune function of patients undergoing radical gastrectomy for gastric cancer have been analyzed. A total of 86 patients admitted to our hospital from March 2021 to March 2022 who received laparoscopic radical gastritis were selected. The combined dexmedetomidine group (n = 43) and the control group (n = 43) are grouped by the random number table method, respectively. Anesthesia induction regimens of dexmedetomidine combined with propofol and conventional propofol are treated, and the changes in serum stress index, immune function index, analgesia score, and pain score are observed. The results show that the postoperative stress response, analgesic effect, and immune function of patients receiving dexmedetomidine combined with propofol anesthesia are significantly better than those receiving conventional anesthesia, and the incidence of postoperative complications in the dexmedetomidine combined group is significantly lower than that in the control group. The results demonstrate that dexmedetomidine combined with propofol anesthesia intervention has high security in undergoing radical gastrectomy for gastric cancer.

1. Introduction

Clinical data show that gastric cancer has a high incidence rate and mortality of malignant tumors. At present, interventional therapy for patients with gastric cancer is radical. Laparoscopic radical gastrectomy for gastric cancer has the advantages of being minimally invasive, less bleeding, and rapid postoperative recovery and has been widely used in clinic [1, 2]. It is worth noting that during the clinical application of the surgical method, due to its long operation time, the operation needs to retain all CO2 pneumoperitoneum. Due to the particularity of the surgical site, a large number of inflammatory factors may be released in patients after an operation. This will seriously reduce the patient's own cellular immune function and will also affect the patient's postoperative pain and recovery [3]. In order to improve the induction effect of general anesthesia, propofol is mainly used to intervene in the hair before radical treatment because of its sedative and hypnotic effects. It can also effectively fight inflammation and protect the immune function of the body [4]. Dexmedetomidine is a highly selective α2 adrenergic receptor agonist that has good analgesic, sedative, and antianxiety effects; positive effects on postoperative emotional state adjustment and pain management of patients; a small impact on patients' neurological function; and certain anti-inflammatory effects [5, 6]. Through clinical trials, this study further explored the efficacy of the right stent microphone combined with propofol in anesthesia, postoperative analgesia, inflammatory response, and cellular immune function in patients undergoing laparoscopic radical gastrectomy for gastric cancer. The results can provide a basis for the follow-up clinical implementation of radical gastrectomy for gastric cancer. In addition, it can provide support in optimizing the perfect anesthesia scheme and improving the effect of surgical treatment so as to promote the rapid rehabilitation of patients.

The rest of the paper is organized as follows. Section 2 discusses related studies, and Section 3 presents the patient data and proposed methods. Section 4 describes the results and analysis. In Section 5, the conclusions are provided.

2. Related Work

Clinical studies have shown that gastric cancer is a common type of malignant tumor disease in the department of oncology [7]. The clinical symptoms of early gastric cancer patients are not typical and obvious adverse symptoms will be present with the progress of the disease. At present, the clinical mortality caused by this disease is relatively high, posing a threat to the life safety of patients [8]. Radical gastrectomy is one of the important methods for the clinical treatment of gastric cancer. The intervention of the surgery can ensure effective resection of the primary lesion and regional lymph nodes of the patient and ensure continuity of the patient's digestive tract while realizing reconstruction of the digestive tract [9]. With the standardization of radical gastrectomy for gastric cancer and the optimization and improvement of related treatment plans, the quality of life, and survival time of patients with gastric cancer have been improved effectively. However, the operation has high requirements on the application and controllability of anesthetic drugs, which require maintaining a certain depth of anesthesia and do not affect the postoperative recovery of patients. Therefore, it is very important to adopt the anesthetic intervention plan to improve the surgical effect and prognosis of patients [10].

Opioid analgesics are commonly used for anesthesia induction, among which remifentanil has no accumulation effect, but it has a fast onset and short half-life clearance, which can produce hyperalgesia to a certain extent [11]. Previous studies have shown that single intravenous drugs cannot anesthetize gastric cancer surgery requirements and should be used in combination [12]. Propofol is characterized by quick awakening and rapid induction, but it has a negative effect on the myocardium and can lead to changes in blood pressure [13]. Dexmedetomidine is mainly metabolized in the liver, and its pharmacokinetic parameters are independent of renal function, age, body weight, and other factors, so its pharmacokinetic controllability is strong, and its half-life is short. Dexmedetomidine can exert a variety of pharmacological properties, which can inhibit or reduce the secretion of norepinephrine, inhibit pain signal transmission, regulate α2 receptors in the postsynaptic membrane, reduce sympathetic nerve activity, and play an antianxiety and sedative role [14]. Relevant studies have reported that dexmedetomidine can produce synergistic effects with other anesthetics, thus reducing the dose of opioids and increasing the stability of anesthesia response [15]. It should be noted that surgical anesthesia, pain, and other stimuli can affect the stability of the internal environment of the body, resulting in varying degrees of secondary stress response. Appropriate stress intensity can alleviate the damage caused by adverse stimuli to the body, and excessive stress response can cause metabolic disorders, affect postoperative recovery, and even endanger the life safety of patients [16].

The immune function damage of patients undergoing radical gastrectomy for gastric cancer is mainly manifested as the decline in the synthesis ability of immune cells and the decreased expression level of peripheral blood immune cells, resulting in immune disorders and even immunosuppression [17, 18]. T lymphocyte subsets are important factors involved in human tumor immunity, in which CD3+ is mainly expressed in peripheral T cells and the thymocyte surface, which has an antigen signal transmission function. CD4+ is the helper T cell, which is mainly synthesized by the thymus cortex. After being stimulated by antigen, CD4+ will differentiate into various subtypes and form immune response and immune regulation functions [19].

In order to improve the postoperative prognosis and quality of life of patients undergoing laparoscopic radical gastrectomy for gastric cancer, attention must be paid to the occurrence of postoperative adverse reactions and reduce the incidence of adverse reactions. Opioids may cause nausea, vomiting, pruritus, respiratory depression, and other adverse reactions during the use of opioids. The synergistic effect of dexmedetomidine and opioids can enhance its analgesic effect and effectively reduce the occurrence of adverse reactions. The antianxiety effect can also effectively reduce the uncomfortable reactions of patients with catheter indwelling, and thus it is a commonly used auxiliary sedative in clinical practice [20].

3. Patient Data and Proposed Methods

3.1. Patient Data

In this study, a total of 86 patients admitted to our hospital for laparoscopic radical gastrectomy were selected from March 2021 to March 2022, and the dexmedetomidine combined group and control group were established by the random number table method, with 43 patients in each group. There are 25 males and 18 females in the dexmedetomidine combined group, aged from 45 to 72 years, with an average age of 57.77 ± 8.25 years. According to the ASA grading standards, there are 12 grade I patients and 31 grade II patients in the group. In the control group, there are 27 males and 16 females, aged from 46 to 72 years old, with an average of 59.37 ± 7.17 years old. According to the ASA classification standard, there are 14 grade I patients and 29 grade II patients in the group. No significant statistical differences were found in the baseline data of gender, age, and ASA classification, which confirmed that the comparison was scientific and reasonable.

All patients included in this study are between 20 and 75 years old and received laparoscopic radical gastrectomy in our hospital, and the patients and their families understood and agreed to participate in this study. Patients complicated with other malignant tumors, patients with serious organic diseases such as liver and kidney diseases, psychiatric history, and cognitive impairment are excluded.

3.2. Proposed Method

3.2.1. Anesthesia Intervention Methods

All patients are fasted and deprived of water for 8 h before surgery, and no preoperative analgesics are used. Intravenous anesthesia is performed with conventional intravenous access. Atropine 0.5 mg is intravenously injected 10 min before anesthesia induction, and the electrocardiogram (ECG), blood pressure (BP), heart rate (HR), and blood oxygen saturation (SpO2) are routinely monitored. The dexmedetomidine combined group is intravenously pumped with 0.5 μg/kg dexmedetomidine for 15 min before anesthesia induction. The control group is injected with a 0.9% sodium chloride injection. The intraoperative maintenance dose of dexmedetomidine in the combination group is 0.2 μg·kg−1·min−1, while the control group received a continuous infusion of 0.9% sodium chloride injection at the same dose. The induction and maintenance of anesthesia in both groups are the same: intravenous injection of midazolam 0.05 mg/kg, propofol 2.5 mg/kg, fentanyl 3.5 μg/kg, and cisatracuride 1.5 mg/kg. After induction, endotracheal intubation is performed orally, mechanical ventilation is performed after endotracheal intubation, and internal jugular vein catheterization is routinely performed. Anesthesia maintenance: During the operation, both groups are continuously injected with cis-atracuride 1 μg·kg−1·min−1, propofol 150 μg·kg−1·min−1, and remifentanil 0.1 μg·kg−1·min−1. Anesthesia infusion is stopped 10 min before the end of the operation, and all patients are treated with intravenous controlled analgesia. Anesthesia is performed by the same anesthesiologist.

3.2.2. Indicators

The changes in stress indexes before and after surgery will be observed. 4 mL of venous blood is collected before and 24 h after surgery, and the supernatant is collected after centrifugation at 3000 r/min for 10 min. The levels of serum cortisol (Cor), adrenaline, and interleukin-8 (IL-8) are detected by the radioimmunoassay. The kits are provided by Shanghai Xinfan Biotechnology Co., LTD.

Analgesia at different time points after surgery is observed. The Sedation Scoring System (Ramsay) and Visual Analog Scoring (VAS) systems are used to evaluate the sedation and analgesia effects of the two groups at 1 h and 24 h after surgery, respectively. In addition, the changes in cellular immune function at different time periods are observed. The levels of peripheral blood T lymphocyte indexes of patients before and 24 h after surgery are detected by the Beckman Kurt CytoFLEX flow cytometry. Furthermore, postoperative complications are observed. Adverse symptoms are observed during the perioperative period, including gastrointestinal reactions, choking, agitation, dizziness.

To analyze the correlation between the cellular immune function of patients and the occurrence of postoperative complications, the Spearman correlation coefficient is used to analyze the correlation between the cellular immune function of all patients included in this study, including the levels of CD3+ and CD4+, and the occurrence of postoperative complications. An analysis of the correlation between cellular immune function and VAS scores will be conducted. The Pearson correlation coefficient is adopted to include the correlation between cellular immune function of all patients in this study, including CD3+, CD4+ index levels, and VAS scores.

3.2.3. Pain VAS Evaluation Criteria

The scale scores from 0 to 10 points, of which unbearable pain is 10 points; <3 points is good analgesia; 3–4 points is satisfactory analgesia; and ≥5 points is poor analgesia.

3.2.4. Ramsay Sedation Score

A Ramsay sedation score is applied, and the scoring range is 1–6. Among them, score 1 represents anxiety, irritability, and restlessness. Score 2 and 3 represent being quiet and sober and lethargic and be able to follow instructions, respectively. Score 4 means asleep but able to wake up. Score 5 represents the sleep state, response to a strong stimulus, or slow reaction. Score 6 represents deep sleep and unable to wake up. If they get 1 point, it means that sedation is not satisfactory. 2–4 points mean sedation and satisfaction, and 5–6 points mean excessive sedation.

3.3. Statistical Treatment

SPSS 26.0 is used to complete correlation analysis for all data included in this study. The measurement data conforming to normal distribution are expressed by mean ± standard deviation, and t-test is carried out. All count data are expressed by (n, %), x2 test is adopted, and the Spearman and Pearson correlation coefficients are used for correlation analysis. P < 0.05 confirmed that data comparison had statistical differences.

4. Results and Analysis

4.1. Changes in Serum Stress Indexes before and after Surgery

There are no significant differences in serum stress indexes including Cor, epinephrine, and IL-8 before surgery (P > 0.05). After surgery, the levels of each indicator in both the groups significantly increased, but the levels of each indicator in the dexmedetomidine combined group decreased significantly than the control group (both P < 0.05), as shown in Table 1. The notation “” represents comparison with before surgery, P < 0.05.

Table 1

Comparison of changes in serum stress index levels between the two groups before and after surgery.

Group	Cor (ng/mL)		Adrenaline (nmol/L)		IL-8 (μg/L)
	Before the operation	After the operation	Before the operation	After the operation	Before the operation	After the operation
The control group (n = 43)	0.45 ± 0.10	0.98 ± 0.17∗	5.77 ± 0.92	18.58 ± 2.01∗	0.29 ± 0.09	0.92 ± 0.17∗
Dexmedetomidine combined group (n = 43)	0.47 ± 0.09	0.73 ± 0.13∗	5.73 ± 0.81	14.72 ± 1.56∗	0.31 ± 0.08	0.58 ± 0.14∗
T	0.975	7.660	0.214	9.948	0.788	10.124
P	0.332	<0.001	0.831	<0.001	0.433	<0.001

4.2. The Analgesia at Different Time Points after Surgery

VAS scores in both the groups increased significantly with time, and VAS scores in the dexmedetomidine combined group increased significantly than those in the control group at all time periods (P < 0.05). The Ramsay score in the dexmedetomidine combined group decreased significantly with time, and the Ramsay score in all time periods increased significantly than that in the control group (all P < 0.05), as shown in Table 2. The notation “” represents P < 0.05 compared with 1 h after surgery.

Table 2

Comparison of the Ramsay score and VAS score at different postoperative time points.

Group	Ramsay scores		VAS scores
	1 h after the surgery	24 h after the surgery	1 h after the surgery	24 h after the surgery
The control group (n = 43)	1.91 ± 0.72	2.07 ± 0.86	3.51 ± 0.51	4.30 ± 0.46
Dexmedetomidine combined group (n = 43)	3.95 ± 0.84	2.86 ± 0.77∗	1.51 ± 0.51	2.53 ± 0.50
T	12.091	4.488	18.274	17.083
P	<0.001	<0.001	<0.001	<0.001

4.3. The Changes of Cellular Immune Function Indexes in Different Time Periods

There are no significant differences in serum CD3+ and CD4+ levels before the operation (all P > 0.05). All immune function indexes in both the groups decreased significantly 24 h after surgery, but all indexes in the dexmedetomidine combined group increased significantly than those in the control group 24 h after surgery (P < 0.05), as shown in Table 3. The notation “” represents comparison with before surgery, P < 0.05.

Table 3

Comparison of changes of serum CD3+ and CD4+ levels in different time periods.

Group	CD3+		CD4+
	Before the operation	24 h after the operation	Before the operation	24 h after the operation
	60.64 ± 2.71	52.59 ± 2.58∗	36.80 ± 2.98	27.29 ± 0.97∗
	60.17 ± 2.57	56.68 ± 2.04∗	36.98 ± 1.22	32.81 ± 2.36∗
T	0.825	8.154	0.367	14.186
P	0.412	<0.001	0.715	<0.001

4.4. The Incidence of Postoperative Complications

The incidence of anaesthesia related complications, including gastrointestinal reactions, choking, agitation, and dizziness, in the dexmedetomidine combined group is lower than that in the control group, and the total incidence of complications decreased significantly than that in the control group (P < 0.05), as shown in Table 4.

Table 4

Comparison of postoperative complications (n, %).

Group	Gastrointestinal reaction	Choking cough	Restlessness	Dizzy	The total incidence
The control group (n = 43)	5 (11.63)	3 (6.98)	2 (4.65)	3 (6.98)	13 (30.23)
Dexmedetomidine combined group (n = 43)	2 (4.65)	1 (2.33)	1 (2.33)	2 (4.65)	6 (13.95)
x 2	—	—	—	—	27.520
P	—	—	—	—	<0.001

4.5. Correlation between the Levels of Cellular Immune Function Indexes of Patients and the Occurrence of Postoperative Complications

Spearman correlation coefficient analysis showed that CD3+ and CD4+ levels are significantly negatively correlated with postoperative adverse complications in patients undergoing laparoscopic radical gastrectomy (all P < 0.05), as shown in Table 5.

Table 5

Correlation between serum CD3+ and CD4+ and perioperative complications of patients.

Indicators	rs	P
CD3+	−0.651	<0.001
CD4+	−0.674	<0.001

4.6. Correlation between Cellular Immune Function and VAS Score

Pearson correlation coefficient analysis showed that postoperative CD3+ and CD4+ levels are significantly negatively correlated with VAS scores in patients undergoing laparoscopic radical gastrectomy (all P < 0.05), as shown in Figures 1 and 2.

Figure 1

Correlation between the serum CD3+ index and VAS score.

Figure 2

Correlation between the serum CD4+ index and VAS score.

5. Conclusions

In this paper, the effects of dexmedetomidine and propofol on postoperative analgesia and cellular immune function of patients undergoing radical gastrectomy for gastric cancer are analyzed. The results show that the postoperative stress response, analgesic effect, and immune function of patients receiving dexmedetomidine combined with propofol anesthesia are significantly better than those receiving conventional anesthesia, and the incidence of postoperative complications in the dexmedetomidine combined group is significantly lower than that in the control group. The results demonstrate that dexmedetomidine combined with propofol anesthesia in laparoscopic radical gastrectomy for gastric cancer can effectively inhibit postoperative stress response, promote the rapid recovery of patients' immune function, reduce the incidence of postoperative adverse reactions, and contribute to the effective postoperative recovery of patients.