Application Of Narcotrend Monitor In Total Intravenous Anesthesia

Objective: This study was designed to explore the clinical effects ofNarcotrend monitor in total intravenous anesthesia(TIVA).Methods：One hundred patients(fifty women and fifty men, ASA grade Ior II) undergoing retroperitoneal laparoscopic adrenal surgery were randomizedto receive a propofol/remifentanyl anesthesia controlled by Narcotrend(Ngroup), or by standard clinical practice(E group), twenty-five men andtwenty-five women in each group. The depth of anesthesia was monitored byNarcotrend monitor in both groups, but in group E the NT monitor was shadedby a black cloth whose data were exported later to be analyzed. Induction ofanesthesia was performed with midazolam0.03mg/kg，sulfentanyl0.4μg/kg，cisatracurium0.15mg/kg，etomidate0.3-0.4mg/kg. A Laryngeal mask airwaywas inserted and mechanical ventilation was performed until the NTS reachedD2level in group N or two minutes after intravenous injection of etomidate.During maintenance of anesthesia, propofol was infused at a rate of6mg/kg/h,remifentanyl was infused at a rate of0.2μg/kg/min initially. Then thepropofol and remifentanyl infusion was adjusted to achieve a NTS of D2-E0ingroup N; the propofol and remifentanyl infusion was adjusted according toclinical parameters in group E. Ten minutes before the end of the surgery, we stopped propofol infusion. When the surgery ended, we stopped remifentanylinfusion. The mean arterial pressure(MAP), heart rate(HR), NTS and NTI wererecorded at9pointes: entering the operation room(T1), induction(T2), LMAinsertion(T3), the beginning of surgery(T5), during surgery(T6), the end ofsurgery(T7), the opening of eyes(T7), pulling out of LMA(T8), orientationrecovery(T9). The total dose of anesthetics, opening eyes time(t1), pulling outof LMA time(t2) and orientation recovery time(t3) were recorded. Duringanesthetic recovery, Ramsay scores, VAS pain scores were assessed; agitation,nausea and vomiting were recorded. The incidence rate of intraoperativeawareness were recorded on POD2. MMSE (Mini-mental State Examination)was performed to value the postoperative cognition dysfunction(POCD) of thepatients on POD2and POD7.Results：The dose of propofol and remifentanyl in group N were fewerthan those in group E（P<0.05）. The vital signs were stable in both groups, andin the N groups the MAP and HR were more stable than those in group E（P<0.05）. More patients in group N achieved the NTS of D2-E0duringsugery than group E（P<0.05）.The opening eyes time, pulling out of LMA timeand orientation recovery time in group N were shorter than those in group E（P<0.05）. There were no difference of Ramsay scores, VAS pain scores,occurrence rate of agitation、vomiting、nausea、intraoperative awareness andPOCD. There were no difference of the dose of propofol and recovery timebetween men and women（P>0.05）. Conclusion：Narcotrend monitor contributes to achieving accurate control ofanesthesia depth, steady-state hemodynamics, reducing the dosage of propofoland remifentanyl and shortening recovery time during TIVA. But Narcotrendmonitor didn’t decrease the rate of intraoperative awareness. There were nodifference of the dose of propofol and recovery time between men and women...