Effects Of Two Anesthesia Strategies Dominated By Propofol And Remifentanil-sufentanil On Achieving Ideal Anesthesia State Under The Guidance Of Bispectral Index

Objective:To investigate the clinical effects of two anesthesia strategies dominated by propofol and remifentanil-sufentanil on achieveing ideal anesthesia state under the guidance of bispectral index.Methods:Sixty patients,ASA I or?,aged 40⁷0 yr,BMI 20²8 kg/m²,scheduled for elective gastrointestinal surgery were randomly divided into two groups?n=30?:propofol group?group P?and remifentanil-sufentanil group?group F?.Opened upper limb venous pathway after patients arrived the operating room,and then connected multifunctional monitor and BIS monitor?BIS,A-2000 monitor,Aspect Medical,USA?.Induction of anesthesia with midazolam,sufentanil,propofolandcisatracurium.Beforeintravenous injection,dosage must be calculated in accordance with weight?kg?strictly.When muscles relaxed,inserted the endotracheal tube with general laryngoscope.Listened to the lung respiratory sound with the stethoscope to make sure that the endotracheal tube in the appropriate position.Remifentanil(Intravenous infusion rate 0.1?g·kg^-1·min^-1)was infused continuously as the background,andpropofol(Intravenousinfusionrate2mg·kg^-1·h^-14mg·kg^-1·h^-1)was regulated mainly in group P;In group F,propofol(Intravenous infusion rate was no more than 2mg·kg^-1·h^-1)was infused continuously,opoids analgesics such as remifentanil(Intravenous infusion rate 0.2?g·kg^-1·min^-10.3?g·kg^-1·min^-1)and sufentanil?according to the need of surgery?was regulated mainly.Intraoperative hemodynamic parameters were maintained stable and ranged of no more than 20%basis,keeping BIS in 45⁶0.When operation finished,patients regained consciousness,while spontaneous breathing recoveried,cough and swallowing reflex regained,endotracheal tube was extubated,and patients was taken to PACU.BIS,MAP,SBP and HR were recorded at six time points:baseline?T₁?,lose of consciousness?T₂?,intubation?T₃?,30 seconds after intubation?T₄?,laparotomy?T₅?.The time of anesthesia and LOC,the recovery time from unconsciousness,the propofol dosage when LOC,the total dosage of propofol,remifentanil,sufentanil,and the vasoactive drug,the Aldrete score,the VAS score,the cases of not in accordance with the BIS range during operation,postoperative nausea and vomiting and intraoperative awareness were recorded.Results:There's no significant difference among two groups in age,weight,height,gender composition?P>0.05?.There was no significant difference in BIS,SBP,MAP and HR between the two groups before induction?P>0.05?;The time of LOC and BIS at the moment of LOC were not significantly different?P>0.05?,while,propofol dosage at the moment of LOC was significantly different?P<0.05?;In the two groups,compared with the intubation,at the moment of 30s after intubation and laparotomy,the difference in BIS,MAP,SBP were significant?P<0.05?,but HR was not?P>0.05?;When operation finished,difference between the two groups,the BIS was significant?P<0.05?,HR,SBP and MAP were not?P>0.05?.The difference of propofol dosage,remifentanil dosage,sufentanil dosage,recovery time,Aldrete score,VAS score were significant between two groups?P<0.05?.In two groups,the cases of not in accordance with the BIS range during operation was 17/30 and 6/30 respectively?the BIS was in 40⁴5 and the duration was longer than 2 minutes?,The cases of using vasoactive drugs to maintain stable hemodynamic parameters was 18/30,4/30?systolic blood pressure was below 30%baseline,or below 80 mmHg,mean arterial pressure was below 60 mmHg,systolic blood pressure was above 30%base value,or mean arterial pressure was above 100 mmHg?,and the difference was significant?P<0.01?.The cases of PONV were 4/30,1/30,the difference was not significant.No case of intraoperative awareness occurred.Conclusion:In group F,during anesthesia,steady hemodynamic changes were found,with smaller BIS fluctuation,better recovery quality,and the anesthesia state was more ideal,better than the propofol group and on the basis of LOC,opoids analgesics can be administrated to maintain the depth of anesthesia.