| Background and Objective:Total intravenous anesthesia (TIVA) has already been utilized in numerous kinds of clinical surgeries for a long time because of its quick effect, anti-irritation to the respiratory passage, relative comfort, easy absorption, non-pollution and convenient operation. Currently, Propofol, Etomidate and Midazolam are the most commonly used drugs in clinical TIVA. Besides the respective advantages and disadvantages of those three drugs, the impacts on hemodynamics during clinical operation also vary in a great range. In total anesthesia, to maintain the hemodynamics stability of the patient is crucial to the safety of anesthesia. Therefore, to select a proper drug is of great significance in TIVA.TCI is a new scientific administration method with an advantage that guarantees a steady and fast effect on reaching preset drug concentration. With this method, the infusion speed of drugs is continuously calculated and controlled to maintain the preset target concentration. TCI has laid the foundation of stability of hemodynamics in total anesthesia.The purpose of this experiment is to provide the evidence for the suitability of different general anesthesia inductions in clinic use. The evidences are obtained through the observation of the effects on hemodynamic index, such as Narcotrend NT, Heart Rate(HR), Cadiac Output(CO), Cadiac Index(CI), Stroke Volume(SV), Stroke Volume Index(SVI), Stroke Volume Resistance(SVR), Mean Arterial Pressure(MAP), using target controlled infusion(TCI) anesthesia with propofol, etomidate and midazolam.Procedure:Choose 60 samples of ASAI-II patients in operation waiting list, divide them into 3 groups, group P number of 20, group E number of 20, group M number of 20. Use propofol TCI on patients in group P (blood target density 2μg/ml), First record the original index from group P before TCI as To. And then record the Narcotrend NT, CO, CI, SV, SVI, SVR index from group P at lmin(T1),3min(T2),7min(T3), 10min(T4) after TCI. for patient in group E, use etomidate TCI with blood target density 0.3μg/ml, record the original index from group E before TCI as To. And then record the Narcotrend NT, CO, CI, SV, SVI, SVR index from group E at lmin(T1), 3min(T2),7min(T3),10min(T4)after TCI. And midatzolam TCI with blood target density 100ng/ml for patients in group M., record the original index from group M before TCI as To. And then record the Narcotrend NT, CO, CI, SV, SVI, SVR index from group M at 1min(T1),3min(T2),7min(T3),10min(T4)after TCI.Result:Various changes occur on patients'NT, HR, CO, CI, SV, SVI, SVR, MAP index after the anesthesia induction (compare to the original indexes). In contrast between three groups, at T3 point the changes on MAP,CO,SV,SVI,SVR have statistic meaning(the index of patients'in group E compared to the index of patients'in group P and M, (p<0.05), and the changes between group P and group M have no statistic meaning(p>0.05); at T4 point the changes on MAP,CO,SV,SVI,SVR have statistic meaning (the index of patients'in group E compared to the index of patients'in group P and M,(p<0.0.5), and the changes between group P and group M have no statistic meaning(p>0.05). The patients'SVR in group E has no obvious changes, but significantly dropped on group P and group M patients. Conclusion:1. TCI of Propofol, Etomidate or Midazolam for 7 minutes for anesthetic induction enables appropriate depth of anesthesia.2. TCI of equivalent dose of Propofol and Midazolam has certain impact on hemodynamics.3. There is no statistical meaning in hemodynamics differences before and after TCI of Etomidate.4. TEB is convenient, economical and non-invasive in monitoring hemodynamics index.5. NT is more intuitive, continuous and accurate in reflecting the depth of anesthesia of the patient. |
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