| Objectives: it is to observe propofol effect-site concentration, the elderly patients anesthesia induction, maintenance, wake the effect of ventricular concentration,observed in elderly age patients receiving general anesthesia, propofol required dose,to find out the proper propofol concentration for anesthesia induction and maintenance of senile patients and to provide reference for clinical practices.Methods: 80 patients receiving endoscopic surgery were divided into two groups,group A (60?69 years old),group B (70?79 years old),40 cases in each group.Group C (?80 years) had too few patients included in the study, and the results were not discussed. In target-controlled infusion propofol induction, the initial concentration was set as 2.0ug/ml and then increased by 0.5ug/ml in gradient till the patients' OAA/S score was 1?2; patients were given rocuronium bromide 0.6mg/kg,target-controlled infusion remifentanil 5ng/ml and patients were intubated till BIS was decreased to 60. During the operation process, BIS was maintained at 45?60 and blood pressure, heart rate were maintained in the range of base value ±30%. The following values were recorded: (1) propofol effect-site concentration, the time point/stage was when OAA/S score was 0 (M1), BIS to 60 (M2), average amount in the maintaining process (M3), patient reviving (M4); (2) BIS value, the time points were when patient's OAA/S score was 0 (B1), patient reviving (B2); (3) patient reviving time (S); (4) Systolic blood pressure (SBP), diastolic blood pressure (DBP),mean arterial pressure (MAP),heart rate (HR) and the record time points were patient admission (TO), OAA/S was 0 (T1), BIS to 60 (T2), 1 min after intubation (T3), 3min(T4),5min(T5).Results:1. Propofol effect-site concentration of group A at M1, M2, M3 and M4 was larger than that of group B at corresponding four time points/stages and the differences were statistically significant (P<0.05).2. Group A and group B (70^79 years old) had no big difference in awakening time and there was no statistical significance (P>0.05).3. Propofol effect-site concentration measured at M2 was larger than that measured at M3 and the difference had statistical significance (P<0.05); propofol effect-site concentration measured at M4 was smaller than that measured at M1, M2 and M3 and the differences had statistical significance (P<0.05).4. Propofol effect-site concentration measured at M2 was larger than that measured at M3 and the difference had statistical significance (P< 0.05); propofol effect-site concentration measured at M4 was smaller than that measured at M1, M2, M3 and the differences were statistically significant (P<0.05).5. Comparison between groups: group A and group B had no evident difference in BIS value when OAA/S was 1-2 and there was no statistical significance(P>0.05);BIS value of group A at reviving was lower than BIS value of group B at reviving and the difference had statistical significance (P<0.05).6. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) values of group A measured at TO were all greater than values measured at T1, T2, T3, T4 and T5.7. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) values of group B measured at TO were all greater than values measured at T1, T2, T3, T4 and T5.8.The mean propofol concentration in the different elderly patients was 2.96 ug / ml(group A),2.71ug/ml(group B) at OAA/S was 1?2;the mean propofol concentration was 3.14ug/ml(group A),2.93ug/ml(group B) at BIS was 60;the mean propofol concentration was 1.2ug/ml(group A),1.05ug/m(group B) at revive.Conclusions:1.The propofol dose in group A (60-69 years) was higher than that in group B (70-79 years) at the corresponding time point.2. In anesthesia induction,propofol target-controlled infusion concentration of 3ug/ml and remifentanil target-controlled infusion concentration of 5ng/ml have a smaller influence on haemodynamics of senile patients.3. In the anesthesia maintaining process of senile patients, BIS value should be kept in the range of 45?60.4. The propofol effect-site concentration maintained in the operation for senile patients should be lower than propofol effect-site concentration when BIS is 60.5.The use of propofol to the elderly patients to provide no response to the sound stimulation of this sedation, the patient may occur after the tongue fall,the choice of sedation concentration need further observation. |
PDF Full Text Request