| Objective: To discuss anesthesia induction in comatose patient with brain injury and consciousness disorders by Bispectral Index to guide the dosage of propofol during anesthesia.Methods: 40 comatose patients with brain injury who will have general anesthesia are randomly divided into 2 groups-Group B(dosage of propofol guided by BIS)and Group G(guided by anesthetist's clinical experience),and slow intravenous injection(within 1 minute)with 0.4?g/kg sufentanil citrate respectively(diluted 20 times with stroke-physiological saline solution),4 minutes later,if,Group B(experimental group,n=20),the BIS of before induction is greater than 50,then target controlled infusion of propofol till the BIS decreases to 40~50 and after that intravenous injection with 1.0mg/kg rocuronium,if the BIS equal or less than 50 and the patients lose consciousness,then inject straightaway with the same dosage of rocuronium;According to patients' vital sign,consciousness status,mandibular reaction and eyelash reflex etc.Group G(controlled group,n=20)will be injected with propofol by anesthetist with clinical experience.Besides,Group G will inject with same dosage of rocuronium as Group B till suitable sedation depth occurs.The plasma target concentration of propofol between the two groups starts to increase from 1.5?g/ml with the incremental gradient of 0.5?g/ml,each plasma target concentration will last 5 minutes till the BIS of Group B stabilizes at 40~50,after achieving the target depth of anesthesia and muscle relaxants come into operation,then change to trachea cannula and proceed manual-controlled ventilation at the same time,after trachea cannula,then change to conventional mechanical ventilation.Intra-operation,using electronic micro-pump to achieve continuous intravenous infusion with 5ug/kg/min rocuronium to maintain muscle relaxation,to achieve continuous infusion with 0.2?g/kg/min remifentanil to ease pain,to achieve continuous intravenous infusion with propofol and inhale isoflurane to maintain the exhaled concentration at 0.8MAC.According to Hemodynamics to adjust the dosage,and keep the MAP above 80~90mmHg before craniotomy and the MAP at 60~70mmHg after craniotomy,if necessary,using electronic micro-pump to achieve continuous infusion with neo-synephrine,dopamine or adrenaline.Respectively observe the BIS?MAP?HR?SABP?DABP and the concentration of hydrocortisone and adrenocorticotrophic hormone in period T0~T3(T0,base state?T1,period after the injection of propofol?T2,tracheal intubation and T3,1 minute after the intubation).Recording the total dosage of propofol during anesthesia induction,the adverse event rates of amyostasia?bradyarrhythmia(HR ?60 per minute)?sychnosphygmia(HR?100 per minute)?the fluctuation of MAP exceeding 20% of basal blood pressure etc.and the usage of atropine and neo-synephrine etc..Results: 1.There was no statistical significance between two groups(P>0.05)in general conditions(gender?age?BMI and ASA),index of correlation(basic BIS?basic GCS?SABP?DABP?MABP?hydrocortisone and ACTH etc.)before anesthesia and electrode position.2.Cyclic change comparison :Intra-group comparison,there was no statistical significance between two groups(P>0.05)in change of heart rate at different time points.Further comparison,it is found out that there was having statistical significance between two groups in change of heart rate at the period of T1~T3: Group G has a higher heart rate than Group B(P<0.05);Groups comparison,there was having statistical significance between two groups in MAP at different time points and MAP changing varying with different time points.(P<0.05):MAP at T2 is lower than T1,T3 higher than T2.But there was no statistical significance in comparing difference between two groups.(P>0.05),.3.BIS,stress reaction index and dosage of propofol comparison: Groups comparison,there was having statistical significance between two groups in BIS difference at T1 period(P<0.05): Group B BIS higher than Group G;there was no statistical significance between two groups in intra-group comparison and group comparison of hydrocortisone and ACTH.(P>0.05).There was having statistical significance between two groups in the dosage difference of propofol before trachea cannula(P<0.05): the dosage of Group G is significantly greater than Group B;after further analysis the connection between propofol,BIS and GCS,it is found out that there are linear positive correlations between the three.Correlations can be described as the following three equations: 1.y=14.219+6.027y(x stands for GCS,y for BIS),2.y=-25.286+1.366x(x stands for BIS,y for propofol),3.y=-65.269+14.016x(x stands for GCS,y for propofol).4.Group comparison of adverse reaction: there was no statistical significance between two groups in usage of atropine(P>0.05);there was having statistical significance between two groups in dosage of MAP higher than 20%,nodal tachycardia,sinus bradycardia and vasoactive drug.(P<0.05): Group B has more chance to emerge the situation of MAP 20% higher than base value than Group G,Group B has a lower rate of other adverse reactions(MAP 20% lower than base value,nodal tachycardia and sinusbradycardia)than Group G,and Group G has more examples of BIS lower 40 than Group B.Conclusion: 1.BIS can individualize to guide anesthesia induction in comatose patient with brain injury and consciousness disorders.It is more objective and safer than experienced dosage.2.BIS can decrease the dosage of propofol during anesthesia induction in comatose patient with brain injury and consciousness disorders.3.Experienced dosage has a higher chance to occur deep anesthesia than BIS during anesthesia induction in comatose patient with brain injury and consciousness disorders.(BIS<40)4.Under the same dosage of anodyne,BIS can stabilize at 40~50 and is better at inhibiting cardiovascular response to intubation during anesthesia induction in comatose patient with brain injury and consciousness disorders. |
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