The Effects Of Different Doses Of Esketamine On Anesthesia Awareness Index (Ai) And Cerebral State Index (CSI)

Objective:This study aims to explore the influence of different doses of eskatemine anesthesia on Anesthesia index(Ai)and Cerebral state index(CSI),two anesthesia depth monitoring indexes,so as to evaluate the application effect and accuracy of Ai and CSI in the monitoring of eskatamine anesthesia.Method:In this randomized controlled trial,90 cases of elective laparoscopic cholecystect-omy and ordinary gynecologic operations under total anesthesia were divided by a casual number form into three groups of 30 cases each: the group of controls(group M),and the experimental group,which received esketamine injection,consisted of0.25 mg/kg(group E1)and 0.5 mg/kg(group E2).Prior to anesthesia,10 ml of sodium chloride,0.25 mg/kg and 0.5 mg/kg of escargot were injected for sedation,and propofol was injected 10 minutes later until the patient lost consciousness after induction of general anesthesia.Anesthesia index(Ai),index of electromyography(EMG1),Cerebral state index(CSI),index of electromyography(EMG2),mean Arterial Pressure(MAP)and heart rate(HR)in three groups were recorded at 1minute(T1)before injection,3 minutes(T2),5 minutes(T3),10 minutes(T4)after injection,1 minute(N1),3 minutes(N2)and 5 minutes(N3)after induction,respectively.The Electroencephalo-graph(EEG)data was collected from T1 to N3 by depth monitor;recording the dosage of propofol during induction of anesthesia in the three groups of patients;recording the MOAA/S scale(The modified observer’s assessment of alertness/sedation scale)of the three groups of patients at T1-T4 to evaluate the depth of sedation of patients.Result:Compared with the three groups of brain wave power: T2～T4 compared with T1,the α wave power was decreased in the E2 group(P<0.05),and the β wave power was increased in the E1 and E2 groups(P<0.05).N1～N3 compared with T4,the α wave power was increased in the M and E2 groups(P<0.05),and the β wave power was decreased in the E1 and E2 groups(P<0.05).α wave power was higher in the M group from T2 to N1 than in the E2 group(P<0.05);β wave power at T2～N3 was higher in group E2 than in group M and E1 as well as in group E1 than in group M(P<0.05).α wave power at T2～T4 was lower in group E2 than in group E1(P<0.05).θ wave power at T2 and N1 was higher in group M than in group E1(P<0.05).Comparison of Ai and CSI data in the three groups: the Ai and CSI data in the E1 and E2 groups were higher in T2～T4 than in T1,and higher in T2～N3 than in the M group(P<0.05).Compared with T4,the Ai value and CSI value of N1～N3 in the three groups were reduced(P<0.05).The Ai values and CSI values of E1 group and E2 group were higher than those in T2～N3(P<0.05).The CSI values and Ai values of the E2 group were higher in T3 and T4 than those in the E1 group(P<0.05),respectively.Spearman’s correlation analysis between Ai and CSI: the correlation coefficients between Ai and CSI in the three groups were 0.820,0.877,and 0.890,respectively.comparison of EMG data in the three groups: the EMG1 and EMG2 data in the three groups were higher in T2～N2 than in the M group(P<0.05).values and EMG2 values were lower in N1～N3 than in T4(P<0.05).Comparing MAP and HR in the Three Groups: MAP and HR were higher in T2～T4 in E1 and E2 groups than in T1(P<0.05).MAP in M group and HR in E1 and E2 groups were less than in T4 in N1～N3(P<0.05).HR in M group and MAP in E1 and E2 groups were less than in T4 in N2～N3(P<0.05);MAP and HR were greater in groups E1 and E2 than in group M from T2 to N3,and MAP and HR were greater in group E2 than in group E1 at T4 to N1(P<0.05).MOAA/S scores at T2～T4 were visually observed to be statistically different between the three groups(P<0.05).The dose of propofol sodium was found to be legally different between the three groups(P<0.05).There was a legal difference in MOAA/S scores between the three groups at T2 to T4(P<0.05).There was a legal difference in the dose of propofol sodium between the three groups(P<0.05).Conclusions:1.In this study,we found that both small and medium doses of esketamine can increase Ai and CSI to different degrees,therefore,neither Ai nor CSI can monitor the true depth of anesthesia of esketamine.2.While propofol has a depressant effect on the CNS and thus decreases the depth of anesthesia Index,which is still at a higher level after using of esketamine.3.In the presence of esketamine,the MOAA/S score could not reflect the sedation depth monitored by Ai and CSI.