Economic Considerations Of General Anesthesia With Bi-level Positive Airway Pressure Ventilation

Background and Objective:Bi-level positive airway pressure (BiPAP) noninvasive mechanical ventilation is apressure support ventilation mode, had the connection through the nose (or face) mask.BiPAP had adjustable inspiratory positive pressure and expiratory positive airwaypressure.Currently, BiPAP ventilation has become a sophisticated ventilation technology,and had a wide range of applications in internal medicine, emergency department andintensive medicine, it has been introduced into clinical anesthesia in recent years.General anesthesia endotracheal intubation with intermittent positive pressureventilation (IPPV) is a safe and reliable method in clinical, but it may sometimes bringserious complications, upper respiratory tract injury and obstruction which can also leadhypoxia, bronchospasm, and arrhythmia, blood pressure fluctuation, regurgitation andaspiration and so on.In order to meet the conditions for tracheal intubation, the anesthesiologist usuallyhave to use a sufficient amount of sedatives, analgesics and muscle relaxants to completetracheal intubation. There has greate risk for elderly and patients with vital organsdysfunction, since these drugs for anesthesia induction has severe inhibition effectivenessto respiratory and circulatory functions, and also serious allergic reactions sometimes.How to reduce the side effects of these drugs is an important subject of the presentstudy. The way which ensure effective ventilation and avoid endotracheal intubation willsolve the above-mentioned problem. BiPAP as a noninvasive ventilation used in clinicalanesthesia can avoid the complications of tracheal intubation, provide new option foranesthesia ventilation technology, and also bring higher demand to anesthesiologists foranesthesia technical and management level.The present study compared two kinds of ventilation mode (venous and inhaled systemic anesthesia) with circulating ventilation index, narcotic drug amount, the qualityof and anesthesia recovery, to assess the clinical application value of BiPAP non-invasiveventilation, and to demonstrate whether BiPAP noninvasive ventilation can reduce clinicalanesthesia costs and amount of narcotic medication while with high quality in anesthesia,and also provide a theoretical basis and clinical support for BiPAP noninvasive ventilationin clinical anesthesia and development, and enhance the ability of anesthesiologistsMaterials and Methods:Sixty adult patients，scheduled for elective laparoscopic cholecystectomy，AmericanSociety of Anesthesia(ASA) I to II，were randomly divided into three groups, with20patients in each group. Group I (intravenous anesthesia+BiPAP noninvasive ventilationgroup), group II (intravenous anesthesia+endotracheal intubation IPPV group), group III(inhalation anesthesia+endotracheal intubation IPPV group). Three groups of patientswere induction with propofol-sufentanil-cis-atracurium.Patients in group I and group IIreceived TCI propofol to maintain anesthesia sedation, patients received inhalation ofsevoflurane in group III. Sufentanil was used for maintenance of anesthesia, andcis-atracurium was given for muscle relaxation.The NIBP、ECG、SpO2were monitored by BeneView T5.And depth of anesthesiamonitored by Narcotrend, controlled Narcotrend index at D. Record the patients’ NIBP、HR、SpO2and NI,before anesthesia (T0), anesthesia induction (T1),1minute aftermechanical ventilation (T2),5minute after mechanical ventilation (T3),15minute aftermechanical ventilation(T4),5minute after pneumoperitoneum (T5),15minute after (T6),30minute after pneumoperitoneum (T7), the end of the pneumoperitoneum (T8) andextubation (T9). Taken arterial blood gas analysis at T0、T4and T6, observation of thearterial blood pH、 PaO2and PaCO2. The consumption of medicaments, times forextubation and stay in the postanesthesia care unit (PACU) were recorded.Results:1. The time of anesthesia induction in group I (51.6±9.8s) significantly shorter than ingroup II and group III (P <0.05).when connect the mask or tracheal intubation, propofoleffect-site concentration in group I（2.6±0.73μg/ml）was significantly lower than group II（3.2±0.15μg/ml）and group II（I3.3±0.09μg/ml）(P <0.05), the NI was significantly higher(P <0.05)in groupI （54±6.8）than group II（39±7.4）and group III(37±5.2). At induction of anesthesia，patients in group I required fewest propofol/sufentanil/cisatracurium（85.6±13.7mg，11.4±2.2mg，5.7±1.2mg）among the three groups. Propofol use did notdiffer at maintained time between group I and group II (P>0.05). Sufentanil andcis-atracurium use group I was also significantly lower than group II and group III (P<0.05), drug dosage were similar in group II and group III (P>0.05).2. Costs for anesthesia induction in group I (118.1±23.1yuan) was significantly lowerthan group II (225.9±30.6yuan) and group III (218.6±28.2yuan)(P <0.05). Inmaintenance phase, medication cost in group III (166.1±24.5yuan,1.8±0.4yuan perminute) was significantly lower than group I (206.2±25.3yuan,2.5±0.5yuan perminute) and group II (210.7±26.2yuan,2.4±0.6yuan per minute)(P <0.05). Totalanesthesia drug costs in group I (360.5±90.7yuan,4.5±0.7per minute on average)wasthe lowest, followed by groupIII(441.0±99.3yuan,5.4±0.8per minute) and group II(502.4±81.2yuan,5.9±1.0per minute), there was significant difference among thethree groups (P <0.05).3. There was no significant difference according to blood pressure and heart rate in threegroups (P>0.05), except at T2and T7phase, group I was lower than group II and groupIII (P <0.05). There was no significant difference according to NI in three groups (P>0.05), except at T1, group I was higher than group II and group III (P <0.05). There wasno significant difference according to arterial blood gas analysis results (P>0.05).4. The extubation time and PACU stay time in group I (3.9±1.4min,11±3.1min)wassignificantly shorter than group II(8.3±2.3min,14.2±3.2min) and group III (9.1±3.1min,15.7±3.7min)(P <0.05). There was no significant difference according to evaluationscore before and after recovery room (P>0.05).5. There was no regurgitation and aspiration in all groups. The incidence of throatdiscomfort was significantly lower in Group than Group II (50%) and Group III (60%),nausea and vomiting incidence in Group III was high than Group I and Group II (P <0.05). Conclusion:1. BiPAP pressure control/support ventilation with face mask can achieve the effect ofmechanical intermittent positive pressure volume control ventilation Laparoscopiccholecystectomy.2. BiPAP mask non-invasive ventilation avoid endotracheal intubation, therebysignificantly reducing the induction drug dose, also significantly reduced anesthesiamedication costs. Patients with BiPAP noninvasive ventilation had quickly andcompletely recovery, shorter time staying in PACU, and showed fewer side effectsafter anesthesia.3. Inhaled anesthetics sevoflurane was associated with lower costs than TCIpropofol-based anesthesia.