A Clinical Study On The Application Of Closed Loop Target Controlled Infusion Of Etomidate Compared With Propofol Guided By Bispectral Index Undergoing Painless ERCP

ObjectiveTo compare the safety and effectiveness of bispectral index guided closed loop target controlled infusion of etomidate and propofol in ERCP surgery.MethodsA total of 60 patients who underwent ERCP examination and treatment under anesthesia in our hospital from June 2017 to August2018 were enrolled in this study.All patients had an ASA grade of I^?and were between the ages of 60⁷5.They were randomly divided into two groups:group P was propofol group?30 patients?and group E was etomidate group?30 patients?.First,both groups received intravenous sufentanil 0.1 ug/kg and then propofol 1 mg/kg for anesthesia induction.After induction in group P,the target plasma concentration of propofol TCI was adjusted to 0.8 ug/ml,and the Slgo's closed loop target controlled infusion?CLTCI?standard maintenance system was started.The BIS target value was set to 60 closed loop self-control and the plasma concentration of propofol was adjusted so that the BIS value was maintained at 60±5.As for group E,the target plasma concentration of etomidate TCI was adjusted to 0.4 ug/ml before the Slgo's CLTCI system was started.The BIS target value was set to 60 closed loop self-control and the plasma concentration of etomidate was adjusted so that the BIS value was maintained at 60±5.Observe and record the change of vital signs at the time of patient entry?T0?,post-induction?T1?,endoscopic?T2?,endoscopic nipple exposure?T3?,and end of surgery?T4?.The number of adverse events such as body motion,respiratory depression,cough,aspiration,low HR,vasoactive drug usage and the total number of adverse events were recorded.The preparation time,operation time,and recovery time of each group were recorded respectively.Results?1?MAP:in the inter-group comparison,the MAP of group E at T2and T3 had a less decline than that of group P,and the difference was statistically significant?P<0.05?.In the intra-group comparison,the MAP of group P decreased at T4 compared with that before anesthesia T0,and the difference was statistically significant?P<0.01?;the MAP of group E decreased at T4 compared with that before anesthesia T0,and the differences was statistically significant?P<0.05?.?2?HR:in the inter-group comparison,the HR of group E at T2 and T3 had a less decline than that of group P,and the difference was statistically significant?P<0.05?.In the intra-group comparison,the HR of group P decreased at T4 compared with that before anesthesia T0,and the difference was statistically significant?P<0.05?;but the HR of group E at T4 did not change much compared with that before anesthesia T0,and the difference was not statistically significant?P>0.05?.?3?SpO₂:in the inter-group comparison,there was no statistically difference between group P and group E?P>0.05?.In the intra-group comparison,the SpO₂ of group P decreased at T4 compared with that before anesthesia T0,and the difference was statistically significant?P<0.01?;the SpO₂ of group E decreased at T4 compared with that before anesthesia T0,and the difference was statistically significant?P<0.05?.?4?RR:in the inter-group comparison,the RR of group E at T3 had a less decline than that of group P,and the difference was statistically significant?P<0.05?.In the intra-group comparison,RR of both groups decreased significantly at the time of T1,T2,T3 and T4 compared with that before anesthesia T0,and the difference was statistically significant?P<0.01?.?5?Intraoperative adverse events:there were differences in the incidence of low HR,vasoactive drug usage,and the total adverse events between the two groups,and the differences were statistically significant?P<0.05?.The numbers of other adverse events were not statistically different between group P and group E?P>0.05?.?6?There was no statistically difference between group P and group E on the preparation time and recovery time?P>0.05?.ConclusionWhen maintaining the BIS around 60 in the ERCP surgery,the closed loop target controlled infusion of etomidate reduces the incidence of low HR,hypotension,and low respiratory rate during surgery;maintains a more stable respiratory and hemodynamic balance;and reduces the incidence of adverse events compared with the closed loop target controlled infusion of propofol.However,there was no delay in the anesthesia preparation time or the recovery time.The overall safety and effectiveness of etomidate anesthesia is much better than that of propofol anesthesia.