| Objective:To observe the effect of intraoperative insulation intervention to the patients with different age, and monitor the concentration, dosage, the recovery time, extubation time, and incidence of postoperative shivering of those patients who were adopted with propofol by total intravenous anesthesia.Methods:The patients who have general anesthesia downlink gastrointestinal surgery and undergoing elective laparotomy were chosen during August to December in 2014 in the hospital affiliated to suzhou university. Their age ranged from 46 to 85, ASAI-II, body index is less than 25 kg/m2, and exclude the severe systemic disease in our study.All of these patients were then divided into four groups randomly. The first group is the patients who are young but with no warmed up, the second group is the patients who are young with warmed up, the third group are the patients who were old but with no warmed up, the fourth group are the patients who are old with warmed up. There are 20 cases in each group. Propofol intravenous anesthesia was adopted to maintain the anesthesia.By adjusting the dosage of propofol to control its concentrations in plasma,so that it can maintain the anesthesia depth in a certain rangement, the BIS value between 40 and 60. Intraoperative continous pump injection of reminfentanil and cisatracurium to keep the patient under analgesia, and muscle relaxant. Intraoperation warm preservation groups are inputted by the heated fluid, covered by warm wind blanket, abdominal cavity douche was heated to 37 degree. No heat preservation group has a routine treatment. Compare the four groups of patients of BIS, SBP, body temperature at pre-operation(T0), intubation(T1), 30 min after anesthesia induction(T2), 60 min after anesthesia induction(T3), 90 min after anesthesia induction(T4), 120 min after anesthesia induction(T5), and the time after surgery(T6), and record these data.Results:Compared these groups in T0 time point, the BIS value in all four groups in T1 time point was decreased, and the difference was statistically significant. While, the BIS value in each point of T1-T6 was no statistic significance.Compared these groups of patients on systolic blood pressure during T0 time point.It showed that systolic blood pressure of the patients in III and IV group decreased at T1 time points(P=0.021,P=0.040),and there was difference.Compared the four groups of patients on temperature.It identified that the temperature of the II and IV group patients was lower than that of the I and III group.In T6 time point,the temperature of I and III groups was 35.49±0.18℃,35.21±0.33 ℃respectively,and the II and IV groups was 36.44±0.28℃, 36.61±0.44℃(P=0.026,P=0.022) respectively. Compared with I group,the temperature of the III group is much lower, there was difference(P=0.027).On the targeted controlled of the drugs,the concentration of II and IVgroups is much lower than that of I and III group.In the T6 time point,the target control concentration of I and III groups was 2.68±0.49mmol/L,2.19±0.44 mmol/Lrespectively,while the II and IV groups was 3.08±0.25mmol/L,2.75±0.23mmol/L(P<0.05) respectively.The results also suggested that the concentration of target control in III group is much lower than the I group, there was difference.There was no statistically difference in anesthetic time of these four groups.The recovery time of group I and III are 27.70±7.95 min,31.15±7.40 min,respectively,while the group II and IV are17.10±4.19 min, 21.10±4.33min(P=0.036,P=0.027) respectively. Compared with youth group I,the elder group III need more time to awake.Accordingly, extubation time is also longer in not warming group and the elderly group.With the dosage of propofol used in group of I and III is significantly lower than that in group II and IV. The dosage in group I and III are 1182.65± 198.80 mg, 1033.25±107. 26 mg,and the group II and IV are 1221.90±102.33 mg, 1166.50±162. 52mg(P=0.043, P=0.048).The incidence rate of postoperation shivering in no warming preservation group I and III was significantly increased,it was 40%,70%respectively.Besides,the incidence rate of postoperation shivering in elderly group III is higher than the young group I.Conclusions:The elder groups have a high incidence rate of intraoperative the initiative to increase the occurrence of low temperature heat preservation,need less concentration and dosage of propofol and long time to recovery,besides,have an increased incidence rate of postoperative shivering. |
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