Effects Of Desflurane Combined With Remifentanil At Different Anesthesia Depths On Early Postoperative Cognitive Function In Elderly Patients Undergoing Laparoscopic Surgery

Objective:Desflurane combined with remifentanil guided by bispectral index was used to maintain the depth of anesthesia,and the effects of different anesthesia depths on early postoperative cognitive function in elderly patients undergoing laparoscopic surgery were observed.Methods:A total of 90 elderly patients aged 65?80 years who were selected to undergo laparoscope-assisted radical resection of colon cancer or rectal cancer in our hospital from March 2019 to September 2019.The patients were randomly divided into deep anesthesia group(D group)and light anesthesia group(L group),with 45 patients in each group.The bispectral index(BIS)was maintained at 30?45 in the deep anesthesia group and 45?60 in the light anesthesia group.Patients in both groups were given intravenous-inhalation combined anesthesia.Mean arterial pressure(MAP)and heart rate(HR)of the two groups were recorded at the time of entering the operating room(T0),5min after endotracheal intubation(T1),pneumoperitoneum immediately(T2),taking out the tumor(T3)and closing the abdominal cavity(T4).Baseline BIS values,operation time,anesthesia time and awake extubation time of the two groups were recorded,the intraoperative BIS values were recorded every 30 minutes at the beginning of the surgery.On the 1st day after the surgery,the improved Brice questionnaire survey was used for interviews and intraoperative awareness was assessed.The score of visual analogue scale(VAS)and postoperative nausea and vomiting were recorded 24 hours after surgery.Patients in the two groups were evaluated by mini-mental state examination(MMSE)1st day before surgery and 1st,3rd and 7th days after surgery,the incidence of postoperative cognitive dysfunction(POCD)was calculated according to MMSE score criteria.Results:At T2,MAP and HR in L group were significantly higher than those in D group(P< 0.05),and there were no significant difference in MAP and HR between the two groups at T0,T1,T3 and T4(P > 0.05).There was no significant difference between the two groups in baseline BIS values,operation time and anesthesia time(P >0.05).The average intraoperative BIS values were 38.32 ± 3.30 in D group and 53.02 ± 4.04 in L group,indicating a significantly difference(P < 0.05).The awake extubation time in D group was significantly longer than that in L group(15.76 ± 4.07 min VS 10.16 ± 3.11 min,P<0.05).Patients in both groups without intraoperative awareness.There was no significant difference in VAS score and postoperative nausea and vomiting between the two groups at 24 hours after surgery(P>0.05).There was no significant difference in the MMSE scores between D group and L group on the 1st day before surgery and 7th day after surgery(P>0.05),and the MMSE scores of D group were significantly higher than those of L group on the 1st and 3rd days after surgery(P <0.05).In L group,the MMSE scores on the 1st and 3rd days after surgery were significantly lower than those on the 1st day before surgery(P<0.05),and there was no significant difference between the MMSE scores on the 7th day after surgery and 1st day before surgery(P>0.05).In D group,the MMSE scores on the 1st day after surgery were significantly lower than those on the 1st day before surgery(P<0.05),and the MMSE scores on the 3rd and 7th days after surgery were not significantly different from those on the 1st day before surgery(P>0.05).On the 1st and 3rd days after surgery,the incidence of POCD in D group was significantly lower than that in L group(P < 0.05),and there was no significant difference in the incidence of POCD between the D group and L group on the 7th day after surgery(P > 0.05).Conclusions:The method of desflurane combined with remifentanil guided by the bispectral index may be more suitable for the maintenance of anesthesia in elderly patients.Compared with the light anesthesia(BIS value 45 ? 60),the deep anesthesia(BIS value 30 ? 45)can reduce the incidence of early postoperative cognitive dysfunction and was more beneficial to the recovery of postoperative cognitive function in elderly patients undergoing laparoscopic surgery.