A Clinical Study On The Appropriate Depth Of Anesthesia And Sedation For Painless Gastroscopy In Patients After PCI

Objectives:Explore the appropriate depth of anesthesia and sedation for patients undergoing painless gastroscopy after PCI（percutaneous coronary intervention）.Methods:A total of 90 patients who needed painless gastroscopy due to up-per gastrointestinal diseases within 6 months after PCI were selected.The American society of anesthesiologists（ASA）gradedⅠ～Ⅲ,and randomly divided into three groups A,B,C by random number table method,30 cases in each group.Age 64-75 years old,including 48 males a-nd 42 females.Intravenous anesthesia was performed with a mixture of 20 mg etomidate,200 mg of 1%propofol and a volume ratio of1:2（EP mixture）.For patients in group A,the anesthesiologist administered EP mixture according to the depth of anesthesia displayed by the bispectral index（BIS）monitoring of the bispectral index（BIS）,and induced gastroscopy until the BIS value reached 50-55.Patients in groups B and C used the same method after induction until the BIS value reached 56-60 and 61-65,then began to enter the gastroscope.Observe and count the three groups before anesthesia（T₀）,after induction to fall asleep（T₁）,gastroscopy through the throat（T₂）,access to the descending duodenum（T₃）,end of endoscope（T₄）,and awakening from anesthesia（T₅）mean arterial pressure（Mean arterial pressure MAP）,heart rate（Heart reat HR）,and pulse oxygen saturation（Peripheral pulse oximeter Sp O₂）.Record the total amount of EP mixture required by the three groups of patients,and record the time to wake up（from the time when the lens is removed to the time when the eyes can be open ed by calling their name）,and the time for orientation recovery（the time for the patient to get out of bed and walk straight for more than three steps）,the total length of gastroscopy（from the beginning of the endoscopy to the end of the withdrawal）,and record the occurrence of intraoperative and postoperative adverse reactions（hypotension is defined as the patient’s MAP decline by more than 20%before anesthesia or blood pressure not exceeding 90/60 mm Hg,hypertension is defined as the patient’s MAP elevation exceeding 20%before anesthesia or blood pressure exceeding 140/90mm Hg;heart rate less than 50 beats/divided into bradycardia,greater than 100 beats/divided into tachycardia;blood oxygen saturation<90%Or apnea>15s is respiratory depression;wake-up time more than 15min after stopping the drug is wake up de-lay）;record the number of occurrences and cumulative time of STT segment changes in the electrocardiogram of the operation,and record the type and number of occurrences of arrhythmia,test and record the changes in the value of High-Sensitivity Cardiac Troponin I hsc Tn I before and 2 hours after the gastroscopy.Results:1.There was no significant difference between the general conditions of the three groups of patients and the total time of gastroscopy（P>0.05）.2.There were statistical differences in the changes of HR and MAP in the three groups of patients during gastroscopy（P﹤0.05）.The hemodynamics of the two groups A and B were more stable during the entire gastroscopy.3.There was no significant difference in SpO₂ between the three groups of patients during gastroscopy,and no respiratory depression occurred（P>0.05）.4.There was a statistically significant difference in the occurrence of adverse reactions in the three groups of patients（P﹤0.05）.Comp-ared with group A and group B,group C had an increased probability of coughing due to body movement,and the difference was statistically significant（P﹤0.05）.None of the three groups of patients showed elevated high-sensitivity troponin I after gastroscopy and STT segment changes in ECG during the examination.5.There was a statistically significant difference in the total amount of EP mixture used by the three groups of patients in painlessgastroscopy.Group A used the most medicine,followed by group B,and group C used the least medicine（P﹤0.05）.6.There was a statistically significant difference between the three groups of patients in the time to wake up and recovery time of orientation（P﹤0.05）.Among them,there was a statistically significant difference in the wake-up time and orientation recovery time between the A and B groups in group C（P﹤0.05）.There was no significant difference in the wake-up time and orientation recovery time between the A and B groups.（P﹥0.05）.