Clinical Study Of BIS Monitoring Propofol Closed Loop Target-controlled Infusion In Children Undergoing Upper Limb Surgery For Intraoperative Sedation And Maintenance

ObjectiveTo compare the clinical effects of three infusion modes of propofol in pediatric upper limb fracture surgery after brachial plexus block,and to explore the most suitable infusion mode for the sedation and maintenance of propofol in pediatric upper limb fracture surgery.MethodsSelect line of upper limb fracture operation,145 cases of pediatric patients,included in the standard:5-10 years old,12-35 kg weight,ASA class ? or ?.The district group was randomly divided into three groups:Constant infusion(CI group n=48),open-loop infusion(OLTCI group n=49)and Closed loop infusion(CLTCI group n=48).The infusion speed of CI group and OLTCI group was manually adjusted by anesthesiologists according to the monitoring indicators and CLTCInical experience of patients.Anesthesiologists in CLTCI group first input the basic information of the children,such as height and weight,into the system,and set the target ideal BIS value,which was automatically regulated throughout the operation to maintain the BIS value within the ideal range.The anesthesia process is divided into anesthesia induction stage and anesthesia maintenance stage.The anesthesia induction stage is from the beginning of intravenous propofol infusion until the ideal BIS value is reached to start the intravenous target-controlled infusion of propofol.In the anesthesia maintenance stage,the anesthesia maintenance mode of the target controlled infusion pump was started approximately 5min before the infusion of propofol was stopped,which was the end of the operation.The TCI injection pump(bcp-100)was monitored by high eeg in the target-controlled pump,and the ideal BIS fluctuation range was 45?60 during anesthesia.After induction,the BIS value should be adjusted to the ideal anesthesia depth value,that is,when the BIS value drops below 60,the intermuscular sulcus nerve block should be performed under the guidance of ultrasound.During the maintenance of anesthesia,the three groups should stop pumping with different infusion modes of propofol 5min before the end of the operation.Intraoperative observation and record established three groups of children in sleep monitoring immediately(T0),to set the BIS value time(T1),the end of the brachial plexus block(T2),immediately after surgery(T3),operation started 30 min(T4),surgery(T5),children with open end(T6)each time point of the MAP,HR,such as the change of the BIS,calculate the MAP and the degree of variation of the BIS,expressed in MAPV,BISV respectively,three groups with calm time(<40 BIS<60),the proportion of time and the dosage of propofol,three groups of target control pump frequency control,consciousness recovery.The occurrence of postoperative adverse reactions such as nausea,vomiting and intraoperative awareness was also recorded.Results1.GeneralThere were no significant differences in gender,age,weight,ASA grading and operation time among the three groups(P>0.05).2.Comparison of MAP,HR and BISThere was no statistical difference in MAP,HR and BIS values between the three groups at T0 and T6,and there was a statistical difference in MAP,HR and BIS between the three groups at T2,T3,T4 and T5(P<0.05).3.The proportion of satisfactory anesthesia time(45<BIS<60)and the dosage of propofolThe proportion of full anesthesia time to total anesthesia time in the three groups was statistically different(P<0.05),and the amount of propofol was statistically different(P<0.05).4.Comparison of average regulating frequency in target-controlled pumpThere was a statistical difference between the three groups(P<0.05),and the regulation frequency of CLTCI group was the least.5.The recovery of anesthesia was compared with the postoperative anesthesia complicationsThe recovery time in CLTCI group was significantly shorter than that in CI group and OLTCI group,and significantly shorter in OLTCI group than that in CI group(P<0.05).There was no significant difference in postoperative nausea and vomiting between the three groups(P>0.05).Postoperative awareness was observed in 1 case in CI group and 1 case in OLTCI group,which was determined as intraoperative awareness.Conclusion(1)Under BIS monitoring,the closed loop target controlled infusion system of propofol can be used in pediatric upper limb fracture surgery.(2)The closed loop propofol system under BIS monitoring has more advantages than the open-loop target-controlled infusion system and the constant-speed target-controlled infusion system,and is more accurate in the dosage of propofol.(3)Under the monitoring of BIS,the hemodynamics of the closed loop target controlled infusion system of propofol in the anesthesia process is more stable,and the anesthesia recovery is faster,which is more suitable for the anesthesia maintenance of the sedation of children with upper limb fracture.