Research Of The Hemodynamic Influence Of Dezocine Using In Tourniquet In The Knee Arthroscopy Operation

Objective:Inflatable power-driven tourniquet is usually using in orthopaedic joint operation, which can provide good view of operation and reduce blooding, but it can also make untoward effect in the operation. With improvement of medical level, anesthetist and surgeon focus on how to reduce or prevent untoward effect of using tourniquet. The objective of this experiment is to observe hemodynamic influence of dezocine using in tourniquet in general anesthesia.Methods: We process this experiment under the permission of Study Ethics Committee of DMU, and we also have informed consent of patients. We chose 66 patients who need knee arthroscopy cruciate ligaments operation using tourniquet. Technician A divide 66 patients into two groups at random equally of Group A a nd Group B use random and double blind method and make disposition of drug and dummy(saline). We open right upper extremity venous channel in operation and intraoperative monitoring non-invasive blood pressure, II lead electrocardiogram, saturation of pulse oximetry(left upper extremity) and brain electricity dual-band index(BIS), before anesthesia induction we use blood pressure as basis, after anesthesia induction we use laryngeal mask(camel man), mechanical ventilate is pure oxygen(2L/min). The maintenance of anesthesia of Group A(matched group) and Group B(experimental group) use venous pump infusing propofol and remifentanil, Technician B use dezocine 10mg(2ml) or saline(2ml) as mainline 15 min before forcing blood to worried extremity as pretreatment( Technician B do not know what is in injector and groups of patients when he makes pretreatment), at beginning infuse 3mg/(kg.h) propofol, adjust propofol in operation to maintain BIS in 45-55, infuse 0.3μg /(kg.min)remifentanil in operation. Using power-driven inflatable tourniquet to displacement and blood pressure before operation, measure non-invasive blood pressure in 5 min interval in operation, if the systolic blood pressure or diastolic blood pressure of the patient exceed 30% of basis, we consider this patient occurring tourniquet dependency high pressure, and record the time of the beginning of this phenomena, and eject experiment after 100 min of tourniquet inflation. If the systolic pressure of the patient exceed 170 mmHg, using vasoactive agent to control pressure and eject experiment. Stop intravenous anesthesia at the end of the operation, and deflate the tourniquet. To prevent nausea and vomiting after operation, intravenous trip 0.3mg ramosetron hydrochloride injection, at last make record of the quantity and time of tourniquet high blood pressure of Group B and Group A record the quantity and time of tourniquet dependency high pressure. We choose 9 points in time from T1 to T9. Technician B record time of patient into operating room(T1), time of 5 min after insertion of laryngeal mask(T2), time of tourniquet inflating(T3), 30 min after inflating(T4), 45 min after inflating(T5), 60 min after inflating(T6), 70 min after inflating(T7), time of loosing tourniquet(T8), the systolic blood pressure(SBP) at 5 min after loosing tourniquet(T9), diastolic blood pressure(DBP), mean arterial pressure(MAP), heart rate(HR), and total quantity of propofol and remifentnil, to do statistic analysis of experimental value.Result: The statistic compare of the experiment value of Group A and Group B is almost the same(P>0.05). In Group A 2 patients are ejected from experiment for systolic blood pressure higher than 170 mmHg, 1 patient is ejected for the time of operation longer than 100 min. In Group B 3 patients are ejected for the time of operation longer than 100 min. The systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure(MAP), and heart rate(HR) of the patients of Group A and Group B at T1 and T2 are almost the same(P>0.05). At T3 and T4, although the systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure(MAP), and heart rate(HR) of the patients of Group A and Group B are almost the same, T1 and T2 of each Group is increasing. The systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure(MAP), and heart rate(HR) of the patients of Group A and Group B at T6, T7 and T8 are statistic different(P<0.05), and the ascensional range of all haemodynamic index is larger than basis at T4 and T5. Heart rate(HR) of the patients of Group A and Group B at T7 and T8 are statistic different(P<0.05)(chart 3). The maintenance dose of propofol for Group A is(65.9±9.3)mg/(kg.min), which is larger than the maintenance dose of propofol for Group B(48.5±7.2)mg/(kg.min), there is statistic different(P<0.01)(chart 2). There is no statistic different because the infusing speed of remifentanil is constant. Conclusion: In general anesthesia using dezocine can improve the hemodynamic influence in tourniquet in the knee arthroscopy operation to rebuild cruciate ligament. Using dezocine before operation can prevent pressure getting higher in operation, in order to maintain blood flow smoothly and reduce the pharmic quantity of intravenous anesthesia, and also reduce incidence rate of untoward effect after operation.