Comparison Of Anesthesia Index、Index Of Consciousness、Wavelet Index And BIS Monitoring In General Anesthesia

Objectives:In this study,Bispectral Index(BIS)was used as the standard to compare the application of Anesthesia Index(AI)、Index of Consciousness(IOC)、wavelet index(WLI)and BIS monitoring in sevoflurane general anesthesia,and evaluate the consistency between domestic anesthesia depth monitor and BIS,and to explore the clinical application value of domestic anesthesia depth monitor.Methods:Sixty patients who met the inclusion criteria and underwent elective laparoscopic cholecystectomy were selected,and subjects were randomly assigned to Anesthesia Index group(group A)、Index of Consciousness group(group Ⅰ)、Wavelet Index group(group W)through a computer-generated random number tab,Each group had 20 subjects.Group A was monitored for AI and BIS,Group I for IOC1(the Sedation in Index of Consciousness)and BIS,and Group W for WLI and BIS.All patients in the three groups signed the informed consent before the trial,collected and recorded general data,such as medical history、xamination results and other data.After the completion of tripartite verification and ECG monitoring,degreasing treatment was carried out on the position of the electrodes for the anesthesia depth monitoring of the patients.The BIS electrode was attached to the left side or the right side,the AI electrode in group A and the IoC electrode in group I were attached to the opposite side,and the WLI electrode in group W was attached to the middle forehead and bilateral mastoid processes.After the monitor was connected,the signal was stable,the patients were asked to rest for 2 minutes,and the index value vital signs of the two anesthesia depth monitors were recorded.All patients in the three groups were anesthetised with propofol sufentanil and rocuronium bromide,and endotracheal intubation was performed after BIS value was reduced to below 60 and muscle relaxation was stabilized for 10 seconds.After successful intubation,mechanical ventilation was performed,and fresh gas flow was set at 2L/min.Sevoflurane and remifentanil 0.15～0.2μg/(kg·min)were used to maintain anesthesia.During the operation,the amount of sevoflurane was adjusted according to BIS,and the BIS value was maintained at 40～60,Sevoflurane and remifentanil were stopped at the end of the operation.The patients were followed up on the first and third days after surgery for whether they had postoperative nausea and vomiting or adverse reactions during the operation.Record before induction of anesthesia(T1)、loss of consciousness(T2)、Immediately before endotracheal intubation(T3)、Successful endotracheal intubation Immediately(T4)、Sevoflurane inhalation beginning(T5)、skin cutting(T6)、pneumoperitoneum completion immediately(T7)、pneumoperitoneum end immediately(Ts)、sevoflurane was stopped(T9)、consciousness was restored(T10)、before extubation(T11)、and 5min after extubation’s(T12)、Heart rate(HR)、mean arterial pressure(MAP),BIS、AI、IOC、WLI、pulse oxygen saturation(SpO2)、end-expiratory carbon dioxide(EtCO2)、body temperature.The minimum alveolar effective concentrations(MAC)of T5-T10 were recorded;Intubation reaction(tears,sweating,body movement)and circulation fluctuation times of remifentanil dosage during the operation were recorded,as well as the type and total amount of vasoactive agents used,times of body movement reactions,operative time,time of recovery,steward recovery score,time of extubation,postoperative nausea,vomiting and other adverse reactions were known during the operation.SPSS25.0 software was used for statistical analysis.Counting data was expressed as frequency and percentage,and the chi-square test was used.Measurement data were expressed as meann±standard deviation((?)),ANOVA test was used for those in line with the normal distribution,while non-parametric test was used for those not in line with the normal distribution,p<0.05 was considered statistically significant Bland-Altman consistency test was used to compare the consistency between AI、IOC、WLI and BIS.Spearman correlation analysis was used to compare the correlation between AI、IOC、WLI and BIS and to draw a scatter plot.Results:Measurement data were expressed as There was no statistical significance in the comparison of basal systolic blood pressure and diastolic blood pressure among the three groups(P>0.05),There were no significant differences in the duration of operation,the amount of remifentanil,the frequency of circulation fluctuation and the amount of vasoactive drugs(P>0.05),postoperative Steward recovery score、recovery time and extubation time showed no statistical significance(P>0.05),no intraoperative body movement reaction or known during the operation,very few patients in group A and group W showed postoperative nausea and vomiting,and there was no statistically significant difference between the three groups(P>0.05).Comparison between groups:There were no significant differences in HR,MAP,MAC and BIS values among the three groups at each time point(P>0.05),there were statistically significant differences in AI value,IOC1 value and WLI value among the three groups at different time points(P<0.05),IOC1 value was lower than AI and WLI value(P<0.05).Intra-group comparison:Compared with T4(immediately after successful intubation),the HR、MAP at T3(before intubation)and Ts(starting sevoflurane)was lower than that at T4(P<0.05),but there were no significant changes in BIS,AI,IOC1 and WLI values between T3～T5(P>0.05).At T2(loss of consciousness),BIS,AI,IOC1,and WLI of the three groups were significantly lower than those of T1(before anesthesia induction)(P<0.05),At the time of T10(consciousness recovery),BIS,AI,IOC1,and WLI of the three groups were significantly higher than those of T9(before sevoflurane withdrawal)(P<0.05).At T5～T9(maintenance period),there was no significant difference between AI and BIS in group A and WLI in group W(P>0.05),the value of IOC1 in group I was lower than that of BIS,and the difference was statistically significant(P<0.05).Bland-Altman analysis showed that 6.0%of points in group A,1.3%in group I and 4.6%in group W were outside the 95%concordence limit,AI、IOC1、WLI and BIS had good concordence.Spearman correlation analysis showed that the correlation coefficients between BIS and AI,IOC1 and WLI were 0.892,0.850 and 0.762(P<0.001),were strongly positive.Conclusions:1 Under sevoflurane general anesthesia,Anesthesia Index、Index of Consciousness、Wavelet Index and BIS all have good consistency and correlation;2 Anesthesia Index、Index of Consciousness、Wavelet Index monitoring can effectively prevent intraoperative awareness,and is safe and feasible in clinical application;3 Anesthesia Index、Index of Consciousness、Wavelet Index and BIS have better responsiveness for changes in consciousness,but the cardiovascular responses to endotracheal intubation stimulation cannot be predicted.