Target Controlled Infusion Of Propofol Anesthesia Guided By Bispectral Index To Explore The Optimal Anesthetic Depth Of ERCP

Objective:To explore the optimal anesthetic depth of ERCP in elderly patients and young patients with a target controlled infusion of propofol anesthesia guided by BIS in a deep sedation state without intubation.Methods:109 patients who underwent ERCP between August 2016 and January 2017 were selected,and all of them were graded as ASA I-II.109 patients were divided into four groups according to age and anesthesia depth,and there were 23-31 patients in each group.In group A,patients were under 65 years old maintaining a BIS of 56-70;in group B,patients were under 65 years old maintaining a BIS of 40-55;in group C,patients were over 65 years old maintaining a BIS of 56-70;in group D,patients were over 65 years old maintaining a BIS of 40-55.All patients were given a target-controlled infusion(TCI)anesthesia of propofol combined with fentanyl.After an anesthesia induction,the TCI concentration was adjusted to a desired range according to the BIS value.Endoscopic operation was started after the BIS value dropped to the desired range and the eyelash reflex disappeared.To observe and record the following conditions and data of each patient:(1)general conditions:name,gender,age,height,weight,BMI,Child-Pugh classification,operation time;(2)changes in vital signs(HR,MAP,SPO2,BIS):T0(admission to the room),T1(after induction),T2(beginning of the surgery),T3(angiography),T4(the end of surgery),T5(awaken);(3)patients' intraoperative adverse events: physical move,respiratory depression,cough,aspiration,use of vasoactive drug,low heart rate,intraoperative awareness and the total number of adverse events;(4)the total dosage of propofol in each group,the time of recovery(withdrawal drug to opening eyes),the effect chamber concentration of propofol at the time of T1 and T5,BIS value when patients were awake.Results:There was no significant difference in the incidence of adverse events among the four groups(p>0.05).The MAP in group C was decreased statistically than that in group D at T1(p<0.05).There was no significant difference in the process of HR change among the four groups(p>0.05).The SPO2 in group C was significantly higher than that in group D at T1 and T2,and SPO2 in group A+C was significantly higher than that in group B+D(p<0.05).The total dose of propofol was significantly lower in group A than that in group B,the dose in group C was significantly lower than that in group D,and the dose in group A+C was significantly lower than that in group B+D(p<0.05).The effect chamber concentration of propofol in group C was significantly lower than that in group D atT1(p<0.05),the concentration in group A was significantly higher than that in group B at T5,and the concentrationt in group A+C was significantly higher than that in group B+D at T5(p<0.05).There was no significant difference in recovery time among four groups.Conclusion:In ERCP anesthesia,the most appropriate depth of anesthesia for both elderly and young patients was BIS value of 55-70.