Effect Of Etomidate Target-controlled-infusion On Hemodynamics In Patients Undergoing Spinal Surgery

Objective:This study is designed to investigate the effects of target-controlled infusion of etomidate on blood catecholamines and hemodynamics in patients undergoing spinal surgery,and compare the impact of the perioperative adrenal function.Methods:Forty adult patients(ASAⅡ ~ III)who underwent elective spinal surgery were enrolled.They were randomly divided into two groups: etomidate group(group E)and propofol group(group P).Each group consisted of 20 patients: group E was the experimental group,target-controlled infusion of etomidate emulsion combined with remifentanil was used for anesthesia;group P was the control group,target-controlled infusion of propofol emulsion combined with remifentanil was used for anesthesia.Anesthesia induction:Before surgery,dexmedetomidine was injected 0.6 μg/kg in 15 min,then both groups were induced with sufentanil(0.3-0.5 μg/kg)+ rocuronium(0.6 mg/kg),group E: etomidate target-controlled infusion,plasma target concentration was 0.6 μg /ml;Group P: propofol target-controlled infusion,plasma target concentration was 4 μg / ml.After two groups patients muscles relaxed,they were treated with tracheal intubation and mechanical ventilation was performed on the anesthesia machine.Maintenance: The plasma target concentration of remifentanil was 6 ng/ml in both groups,the plasma target concentration of etomidate in group E was 0.5-1.0 μg/ml,and the plasma target concentration of propofol in group P was 2-4 μg/ml.(According to the BIS value,maintain BIS value 40 ~ 60),intermittent intravenous injection of rocuronium bromide as needed.Pre-anesthesia(T0),post-induction(T1),intubation(T2),surgical incision(T3),after operation(T4),postoperative 24 hours(T5),postoperative 48 hours(T6)monitoring heart rate(HR),mean arterial pressure(MAP),and T0,T4,T5,T6 were used to extract venous blood,determination of plasma adrenaline(E),norepinephrine(NE),cortisol(Cor)were measured.Observe the postoperative recovery time,time of extubation,and adverse reactions of patients.Result:1)Hemodynamic changes:Compared with T0 before anesthesia,the HR values of the two groups changed significantly at T1 before intubation,but the decrease in P group was greater(P<0.05).There was no significant difference in HR between the two groups at T2~T4(P(29)0.05).Compared with T0 before anesthesia,the MAP values of the two groups were significantly changed at T1 before intubation,but the decrease was greater in P group(P<0.05).There was no significant difference in MAP between the two groups at T2~T4.(P(29)0.05).2)Comparison of plasma cortisol,epinephrine and norepinephrine concentrations:Compared with T0,the plasma cortisol concentration at the T4 was significantly higher in the two groups(P<0.05),and the group P was more significantly elevated(P<0.05)at 24 hours after surgery.At the time of T5 and T6,both groups could return to pre-anesthesia levels.Compared with T0,the plasma concentrations of epinephrine and norepinephrine were significantly increased at the time of T4、T5(P<0.05).The elevation of adrenaline and norepinephrine in the P group was more significant(P< 0.05);both groups of patients returned to pre-anesthesia levels at time T6;3)Comparison of recovery index and adverse reactions between the two groups:The recovery of the two groups was as follows: the recovery time of the E group and the time of removal of the tracheal tube were significantly longer than those of the P group,and the results were significantly different(P<0.05).Complications occurred after anesthesia in the two groups: 11 patients had complications in group E,including 1 case of injection pain,3 cases of myocardium,4 cases of postoperative agitation,3 cases of vomiting,and concurrent occurrence of group P.There were 5 cases of symptoms,4 cases of injection pain,and 1 case of postoperative agitation.There was no significant difference in the complications between the two groups(P>0.05).Conclusion:1.Target-controlled infusion of etomidate emulsion in patients with spinal surgery,etomidate and propofol have good hemodynamic stability,because etomidate has stable hemodynamic characteristics,it can be safe It is used for induction and maintenance of general anesthesia.2.Target-controlled infusion of etomidate can produce transient adrenal cortical inhibition when anesthesia is maintained in patients undergoing spinal surgery.It can be restored to preoperative level 24 to 36 hours after surgery.Effectively applied to patients undergoing elective surgery anesthesia maintenance(<4h).