The Feasibility Study Of Target-controlled Infusion Of Remifentanil In General Anesthesia Of Children

Objective To compare the difference of remifentanil target-controlled infusion system to set the target plasma concentration (target concentration, Ct) with the measured plasma concentration (measured concentration, Cm) in pediatric general anesthesia. At the same time two different concentrations of remifentanil and propofol target-controlled infusion of the children were carried out by continuous monitoring of bispectral index (BIS) and auditory evoked potential index (AEPI) and other indicators as well as the depth of anesthesia mean arterial pressure and heart rate and other hemodynamic parameters, analyzes the maintenance of general anesthesia in the pediatric course will enable the children maintained at a satisfactory depth of anesthesia, under remifentanil and propofol target-controlled infusion of appropriate doses for clinical anesthesia in children in China provide a reference basis for rational drug use.Methods ASAⅠgrade, age 3 to 12 years, elective tonsillectomy in children 40 cases were randomly divided into 2 groups (R2 group and the R4 group) in 20 cases, plasma concentrations of target-controlled infusion of remifentanil were 2ng/ml and 4ng/ml respectively. TCI5, 10,20,30,40,50,60 min extraction radial artery 2ml, containing 50% citric acid into 40ul of heparin tube, through the high-performance liquid chromatography (HPLC) for detection of remifentanil in plasma concentration. In addition, by adjusting the target-controlled propofol plasma concentrations so that children remain at a suitable depth of anesthesia after (T0), after the target-controlled infusion 3min (T1), before tracheal intubation (T2), trachea after intubation (T3), and when the removal of tonsils (T4) .The heart rate (HR), mean arterial pressure (MAP), bispectral index (BIS) and auditory evoked potential index (AEPI) values were included into the statistical analysis.Results①TCI 5 ~ 30 min, in the measured R2 remifentanil group and the R4 group, Cm was lower than Ct, the difference was statistically significant (P <0. 05), TCI 40 ~ 60 min, Cm was close to Ct value, difference was not statistically significant.②Evaluation of Remifentanil TCI system performance deviation and accuracy were within the acceptable range in clinic.③R2 group of children with T3 time point MAP, HR, BIS, and APEI time point compared with T0 were significantly higher (P <0. 05 ).④R4 group of children with various indicators, when T3 compared with T2, the difference was not statistically significant (P> 0.05).⑤6R2 group of children with T4 time point MAP, HR decreased slightly compared with the T0 point in time, no statistically significant difference (P> 0.05).⑥R4 group of children with T4 time point compared with T0; MAP, HR, BIS, and APEI point decreased significantly (P <0. 05).Conclusion Remifentanil for 2ng/ml and 4ng/ml, the idea of high-TCI-I-type systems pharmacokinetic parameters of the deviation, precision in the clinically acceptable range. In addition, the concentration of target-controlled infusion of remifentanil 4ng/ml, while composite target-controlled infusion of propofol, can maintain the value of BIS and AEPI in clinical anesthesia state, at the same time can keep intraoperative hemodynamic relatively stable.