Clinical Study Of Closed-loop Target Controlled Infusion Of Propofol And Etomidate Combined Application

Objective:To investigate the effect of closed-loop target controlled infusion of propofol and etomidate combined application in laparoscopic gastric cancer surgery.Methods:Choosing 120 undergoing elective laparoscopic surgery of gastrointestinal carcinoma patients who are on the basis of ASA ?to ? classification Grade,age from18 to 75 years old,a body mass index of 18-24kg/m2,recently the use without taking any contain hormone drugs,and without serious disease of heart lungs hepatorenal,metabolic,anemia and shock of haingelectie,were randomly divided into four groups(n = 30): propofol group(group A),the etomidate group(group B)propofol combination of an etomidate open-loop group(group C),and propofol combination of an etomidate closed-loop group(group D).Respectively,observe and record the change of SBP,DBP,MAP,HR,BIS in different time points :before anesthesia(T0),before the endotracheal intubation(T1),endotracheal intubation(T2),1 minutes(T3)after endotracheal intubation,endotracheal intubation after 5 minutes before(T4),cut skin(T5),cut the skin(T6),cut skin after 5 minutes(T7 has),when the pneumoperitoneum(T8),sewing leather(T9),at the end of surgery(T10),trachea(T11),pull out the operating room(T12);Determination of extracting venous blood plasma cortisol concentration in different time points : pre-anesthetic,the end of the operation,24 h and 48 h after application;through adopting the artery blood gas analysis record the concentration of Na~+,K~+ in different time points:pre-anesthetic,after the end of the operation;Record intraoperative all kinds of anesthetic dose,infusion volume,waking time,recovery time and extubation time of patients after stopping drug;At the same time,record when anesthesia induction and injection pain,postoperative follow-up whether intraoperative know,nausea and vomiting whether occurred adverse reactions situation.Results:1)Comparison of Hemodynamics and BIS:Comparison within the groups:SBP,DBP,MAP,HR and BIS of T1 were significantly decreased than pre-anesthesia T0 in four groups,T1,T3 and T4 compared with the previous time points,the change of SBP,DBP,MAP was the most obvious reduction.SBP,DBP,MAP of T2,T6 and T8 were obviously higher than the previous time points(P < 0.05),compared with T0,SBP,DBP,MAP and BIS of T11 and T12 were no statistical significance(P >0.05).Comparison between groups: There was no significant difference in SBP,DBP,MAP,HR and BIS between the four groups(P> 0.05).Group C and group D compared with group A,SBP,DBP and MAP reduction in T1,T3 and T4 was obviously lower,SBP,DBP and MAP elevation in T2,T6 and T8 was obviously higher than the previous time point,there was no significant difference in SBP,DBP and MAP at other time points(P> 0.05).Group C and group D compared with group B,SBP,DBP and MAP reduction in T1,T3 and T4 was obviously increased,SBP,DBP and MAP elevation in T2,T6 and T8 was obviously lower than the previous time point,there was no significant difference in SBP,DBP and MAP at other time points(P> 0.05).Group A compared with other groups,the change of BIS was significantly decreased in T1,group B compared with other groups,the change of HR was significantly increased(P < 0.05),comparison differences of HR and BIS had no statistical significance at other time point(P > 0.05).There was no significant difference in SBP,DBP,MAP,HR and BIS between group C and group D(P> 0.05).2)Comparison of anesthetic dosage,infusion volume: The dosage of propofol was orderly decreased in group A,C and D,and the dosage of etomidate was orderly decreased in group B,C and D(P <0.05).Compared with group C,the dosage of propofol and etomidate was significantly reduced in group D;group B,group C and group D compared with group A,the dosage of remifentanil was significantly increased and the infusion volume was significantly decreased(P <0.05)There was no significant difference in the dosageof remifentanil and infusion volume between group C and group D(P> 0.05).3)Waking time,recovery time and extubation time comparison:postoperative waking time and recovery time were extended in turn according to group A,group D,groupC and group B;Compared with group B,postoperative waking time and recovery time was significantly shorter in group A and group C and group D(P <0.05);there was no statistically significant difference in postoperative recovery time and waking time between Group C and group D,the comparison difference of decannulation time between four groups had no statistical significance(P > 0.05).There was no significant difference in extubation time between each group(P> 0.05)4)Plasma cortisol concentration comparison: Plasma cortisol concentration in finish,after 24 hours and 48 hours of group B,group C and group D was significantly lower than before operation(P <0.05).There was no significant change in plasma cortisol concentration after 48 hours compared with before operation.Compared with group A,the plasma cortisol concentration of finish and after 24 hours was reduced significantly in group B and group C and group D(P < 0.05);There was no significant difference in plasma cortisol concentration between group C and group D at each time point(P> 0.05).5)Na~+,K~+: There was no significant difference between before and after surgery Na~+,K~+in four groups(P> 0.05).6)Adverse situation: compared with group A,the incidence of intraoperative hypotension and injection pain was significantly decreased in group C and group D,compared with group B,the incidence of myoclonus and hypertension was significantly lower in group C and group D(P < 0.05),patients of four groups had no intraoperatie awareness(P > 0.05).Conclusion:closed-loop target controlled infusion of propofol and etomidate combined application has a lot of benefits that can make less cycle fluctuations during anesthesia,hemodynamic smoother,more accurate anesthesia depth controllability,reduce anesthetic drugs and adverse reaction,restrain stress reaction,which truly realized the automatic control and individualized anesthesia.