Target-controlled Infusion Of Remifentanil And Propofol Is Used In Lower Lomb Orthopedic Surgery Of Elderly And Non-elderly Patients

Object: To compare the impact of anesthesia via target-controlled infusions ofremifentanil and propofol on intraoperative hemodynamic stability, recovery andadverse events between elderly and non-elderly patients in lower limb orthopedicsurgery.Methods: It is to choose the elderly of over the age of65and non-elderly of underthe age of60who will do selective operation of lower limb orthopedic surgery undergeneral anesthesia. American Society of Anesthesiology standards (ASA standards) Ⅰ-Ⅳ are used. This study includes40patients that can be separated into the elderly group(Group1of9male cases and11female cases) and the non-elderly group (Group2of12male cases and8female cases). Ages: Group1of （81.8±7.54） years old; Group2(41.95±14.86) years old. Two groups of patients are all used the anesthesia of totalintravenous anesthesia TCI remifentanil and propofol.Anesthesia induction: The two kinds of anesthesia induction way are the same.The plasma concentration of target-controlled infusions of remifentanil is set to4ng/ml;induction time3minutes. After target controlled infusion pump works3minutes,midazolam(0.03mg/kg), etomidate (0.2mg/kg)and Cisatracurium(0.2mg/kg)are givensuccessively. Maintenance of anesthesia: it is to do target-controlled infusions ofpropofol after intubation, target plasma concentration is set up as3ug/ml, and inductiontime is set to10minutes. It is to add sufentanil according to the reaction of intubation (to give phenylephrine, ephedrine or atropine I.V when hypotension or sinusbradycardia happens).Monitoring indicators:1) To observe and record BIS value, the in-and-outamount of fluid during the surgery, the amount of anesthetics used, the usage ofvasoactive agent, awakening time, extubation time, postoperative adverse reactions,postoperative and one hour postoperative VAS and anesthesia satisfaction scoring. TheMMSE scoring of the elderly group is estimated.2) The common monitoring indicatorsof two groups: HR, SBP, DBP, MAP, BIS; the monitoring indicators added to Group1:CO, SV, SVV%. Monitoring time point: time of basic value（T0），remifentanil rising toplasma concentration（T1）, before intubation（T2）,intubation（T3）,3minutes afterintubation（T4）, propofol rising to target plasma concentration（T5）, skin incision（T6）,30minutes after skin incision（T7）, the highest blood pressure during the surgery（T8）,the lowest blood pressure during the surgery（T9）, extubation（T10）, ten minutes afterextubation(T11).Result: It is to use T test to compare the time point of SBP, DBP, MAP, HR withinthe group of the non-elderly group and the elderly group. It is to use Chi-Square tocompare the basic value（T0）of the incidence of volatility (the incidence ofhemodynamic instability).The incidence of range of more than30%of heart rate andblood pressure are defined as fluctuation (hemodynamics fluctuation). The HR of thetwo groups differs in incidence of fluctuation at the time point of T2、T3and T4compareto T0(p<0.05). The SBP、DBP and MAP do not differ in the incidence hemodynamicfluctuation at every time point (P>0.05). The BIS value of the two groups with twosample mean inspection group design (t test) and basic values between groups (T0)differ. The plasma concentration （1ng/ml、2ng/ml、3ng/ml、4ng/ml）at the time ofinduction target remifentanil to plasma concentration4ng/ml has no statisticalsignificance to BIS value and respiratory depression.The restoring time of the two groups have no statistical significance（P>0.05）.The postoperative and one hour postoperative VAS have no statistical significance （P>0.05）, The MMSE of preoperative and postoperative scoring of Group1has nostatistical significance. Two shivering cases and one atrial fibrillation happen in Group1.Two shivering cases happen in Group2.Conclusion: Remifentanil has no significant inhibition to respiratory and vascularsystem and BIS value has no difference with basic value when plasma concentrationrises to4ng/ml. The anesthesia way of target-controlled infusions of remifentanil andmaintaining with propofol can be applied in elderly and non-elderly patients safely andeffectively. However, the propofol of plasma concentration3ug/ml has strong inhibitionto the elderly group. The intubation reaction of Group2cannot be inhibited by4ng/mlremifentanil. The hemodynamics is relatively stable of the two groups during theanesthesia.(The incidence rate of hemodynamics of volatility is no more than30%).TCI system can be safely and effectively used in adults who do selective operation oflower limb orthopedic surgery under general anesthesia.