The Clinical Value Of Tip Perfusion Index In Monitoring The Stress Response During The Operation Of Laparoscopic Cholecystectomy

Object:To observe the change and relativity of TPI and SBP, DBP, HR and BIS under different stimulations, evaluate the clinical value of TPI in monitoring the stress response during the operation of laparoscopic cholecystectomy.Patients and Methods:Thirty ASAâ… -â…¡patients undergoing laparoscopic cholecystectomy under general anesthesia were enrolled in this study. After entering operation room the patients were monitored with SBP, DBP, HR, TPI, BIS and the skin temperature of finger. Anesthesia was induced with midazolan 0.05 mg/kg, fentanyl 5μg/kg and propofol effect room 4.5μg/ml by TCI. Tracheal intubation was facilitated with vecuronium 0.12mg/kg. Anesthesia was maintained with TCI of propofol (target effective room concentration was set at 3.0μg/ml) and remifentanil 0.25μg/kg/min. The patients were mechanically ventilated (VT 8-12 ml/kg, RR12-16bpm, I:E1:2). P_ETCO₂ was maintained at 35-45mmHg by adjusting ventilate volume per minute. The pressure of artificial pneumoperitoneum is below 2kpa.The TPI, the skin temperature of finger, BIS, SBP, DBP and HR were observed at the time point as following: before induction of anesthesia(T₀), after induction of anesthesia and before intubation(T₁) , immediately intubation(T₂) , 5 min after intubation(T₃), immediately skin incision(T₄), 1 min after pneumoperitoneum (T₅)and 5 min after pneumoperitoneum(T₆), immediately straw Cholecy(T₇), 1 min after stopping pneumoperitoneum (T₈), immediately extubation (T₉), 5 min after extubation(T₁₀).Results:As compared with the baseline at T₀, BIS value was significantly decreased at T₁-T₈ (P<0.05). There is no significant difference at T₉-T₁₀(P>0.05); TPI value was increased at T₁,T₃,T₁₀(P<0.05); decreased at T₂, T₄-T₇(P<0.05). SBP and HR value were increased at T₁, T₃(P<0.05); increased at T₂, T₅-T₇(P<0.05);DBP value was decreased at T₁(P<0.05), increased at T₂, T₅-T₇, T₉(P<0.05). As compared with immediate intubation at T₂,TPI value was increased at T₃,T₈-T₁₀(P<0.05).TPI value was decreased at T₅(P<0.05);SBP and HR were decreased at T₃-T₄, T₈-T₁₀(P<0.05); SBP value was increased at T₅-T₆(P<0.05).HR was increased at T₅(P<0.05). DBP value was decreased at T₃-T₄,T₈,T₁₀(P<0.05).As compared with pneumoperitoneum at T₅, TPI value was increased T₆-T₁₀(P<0.05); SBP, DBP, and HR value were decreased at T₆-T₁₀(P<0.05).As compared with immediate extubation at T₉,TPI value was increased at T₁₀(P<0.05); SBP, DBP, and HR were decreased(P<0.05).The skin temperature of the finger tip has no significant difference( P>0.05)during the whole operation. TPI was negatively correlated with SBP, DBP, and HR (r=-0.963, -0.908and -0.957, respectively p<0.05).There is no relation between TPI and BIS (r=-0.188,0.067, respectively P>0.05).Conclusion:1. TPI could provide anesthesiologists some reference in judging the intra-operative nociception when BIS is monitored and adequate sedation is ensured. 2. TPI could be used to monitor the sympathetic reactively, noninvasively, instantly and continuously during general anesthesia.3. TPI was influenced by many situations, and the value of monitor tense of sympathetic nerver as the response of stress will be in further research.