Feasibility Study Of CONCERT-CL Feedback Loop Target Controlled Infusion System For Propofol Intravenous Anesthesia Combined With Inhalation Of Sevoflurane

Background:with the continuous development of anesthetic technique, a single intravenous anesthesia, intravenous anesthesia, target concentration control of intravenous anesthesia (target controlled infusion, TCI) and inhalation anesthesia andcombined intravenous inhalation anesthesia have been used in clinical anesthesia. The application of EEG double spectrum (BIS) monitor as the representative of the depth of anesthesia monitoring clinical application, to guide the rational use of drugs in clinical anesthesia, avoid anesthesia too shallow lead to anesthesia complications have important guiding significance. BIS combined with TCI to form a closed loop target controlled infusion for propofol intravenous anesthesia, and achieved good clinical results. However, it is worth discussing that the closed loop target controlled infusion system guided by BIS is in combined intravenous and inhalation anesthesia.Objective:The present trial was aimed at evaluating the feasibility of Bispectral Index(BIS)-guided CONCERT-CL closed-loop anesthesia delivery system for propofol intravenous anesthesia combined with seven sevoflurane inhalation anesthesia. Methods:Forty-five adult patients (aged 25-65years, ASA I or II grade)scheduled for gynecological laparoscopic operation procedures of an expected duration of 90 to 300 minutes were randomized into 3 groups, each group of 15 cases: respectively is 0% sevoflurane group (group So),0.5% sevoflurane group (group S1) and 1% sevoflurane group (group S2). BIS guided by CONCERT-CL closed loop system (closed loop TCI) controlled by intravenous propofol anesthesia induction, closed loop TCI control of propofol and inhaled different concentrations of sevoflurane anesthesia maintenance.Induction of anesthesia:BIS set 40-50, propofol target controlled concentration of 2.5μg/ml TCI, fentanyl 3μg.kg-1 intravenous bolus, Shun cisatracurium 0.15mg.kg-1 muscle relaxation monitoring feedback input vein when BIS below 70 and automatically maintain in. Maintain anesthesia: BIS set 45 to 55, propofol target controlled concentration of 2.0μg/ml TCI, fentanyl 0.1 mg intravenous injection after pneumoperitoneum and remifentanil 300μg.h-1 intravenous infusion after operation 30min.The total intravenous anesthesia, the minimum target concentration of propofol TCI is set to 1μg/ml. Intravenous Inhalation Anesthesia, the minimum target concentration of propofol TCI is set to 0.5μg/ml. Maintenance of anesthesia, Drager GS anesthesia machine automatically complete each predetermined end tidal sevoflurane concentration, oxygen flow rate 2.0L. When the peritoneum is closed, the suction is stopped when the sevoflurane and the pump are injected with the CIS type of the ammonium bromide, and the target controlled infusion of propofol is stopped when the skin is closed. Surgery in patients with blood pressure and heart rate changes over baseline blood pressure and heart rate of 20%, corresponding to a given phenylephrine, nitroglycerin, atropine or esmolol treatment. Observation under the guidance of bis auxiliary 0%,0.5% and 1% sevoflurane anesthesia of propofol closed-loop infusion anesthesia in patients undergoing laparoscopic surgery in before anesthesia induction (To), immediately after intubation (T1), before pneumoperitoneum (T2), pneumoperitoneum after 10 min (T3) and operation end (T4) the patient’s heart rate, blood pressure, BIS value and the end of anesthesia with propofol total amount and recovery time of patients.Result:There was no significant difference in age, BIM and ASA grades between the three groups. Three groups of patients with T1 to T5 BIS are between 40 to 60 at each time point, the change was not statistical significance (P> 0.05). Recovery timeof three groups of patients was respectively5.40±0.91,5.53±1.46 and 5.00±1.56, the difference was not statistically significant (P=0.368).Three groups of patients were notpostoperative agitationand intraoperative awareness.Three groups of patients of SBP with the same point of time change was not statistically significant (P> 0.05).Each group of SBP changed within 20% at different time points.The change of diastolic blood pressure of three groups was not statistically significant (P> 0.05);Each group of DBP changes within 20% at different time points.Three groups of patients with the same point of time the heart rate was not statistically significant (P> 0.05).The dosage of propofol anesthesia in patients with (5 mu g. g-1. Min-1):So group (86.26±21.44)> S1 group (68.11±13.87)> S2 group (54.88±11.89),statistically significant difference between the groups,there was statistically significant (P<0.01), The dosage of propofol of maintain anesthesia in patients with (5 mu g. g-1. Min-1):S0 group (71.27±21.89)> S1 group (54.77±15.07)> S2 group (41.42±9.55), statistically significant difference between the groupswas statistically significant (P <0.01).Conclusion:CONCERT-CL Closed loop target controlled infusion system under the guidance of BIS can be used for the management of sevoflurane inhalation anesthesia with propofol, significantly reduce the dosage of propofol, anesthesia more stable and controllable patient recovery time, no postoperative restlessness and intraoperative awareness.