Conparison Of Clinical Effects Between Target-Controlled Infusion And Intravenous Midazolam

Objective Midazolam is a kind of new BZ ramification withquicker effect,shorter T1/2 ,less bad reaction,wider safe range andless inhibition of circulation than other BZs.Single infusion ofmidazolam is commonly used for induction of general anesthesia.But we should increase the dosage of other anesthesic drugs tostablize the course of the operation and get the best effect ofanesthsia,which usually leads to recovery delay .In thisobservation,we try to discuss the clinical effect of midazolamadministered by target-controlled infusion in general anesthesia andexpect to get a more reasonable way in clinical use.Method Forty ASA Ⅰ～Ⅱ patients ,scheduled for electiveabdominal surgery under general anesthesia were enrolled in thestudy ,and their ages were between 29～63 years,their weightswere limit to 20% fluctuation of their normal weights.They hadnormal function of heart,lung, liver and kidney. And the patientswere randomly allocated into two groups ( 20 in each group),groupT (midazolam was infused by TCI) and group C (midazolam wasinfused once). We monitored ECG,HR,BP,SPO2,BIS ( maintained40 ～ 60 ,observed by multi-monitor produced by Huaxiangscientific corp. Heilongjiang),HRV (total range 0.03Hz ～0.35Hz).We stick five ECG anodes on the patients'forehead andcansus after degreasing by colors.HRV could be monitoredaccording to ECG.The patients were premedicated withintramuscular scopolamine 0.3 mg.Anesthesia of group T wasinduced with midazolam by TCI-I (produced by Silugaocorp.Beijing ) with the effect target concentration 300ng/ml andthe recovery concentration 100ng/ml until suture of abdominalwall,and anesthesia of group C was infused with midazolam withthe concentration of 0.1～0.15mg/kg .Group T and group Ccontinued to be induced with Fentanly 4 ug/kg,vecuronium 0.08～0.1mg/kg , propofol 1～2 mg/kg of group C ,then intubationcompleted . Datex -Ohmeda anesthesic device was connected formechanical respiration ,tidal volumn 10～15ml/kg , respiration rate12～15/min.Anesthesia was maintained with Enflurane and theother medicine according to BIS and HRV alteration. Observingitems: 1.In all the patients, ECG,HR,BP,SpO2 were monitored.2. SBP,DBP,HR,BIS,HRV,MAC were recorded at entering-room(T0), intubation (T1), beginning operation (T2),the strongest stressin the operation (T3),extubation (T4). 3.We monitored theconsumption of medicine. 4.We recorded the recovery time ofbreath and the tracheal extubation time and the state of thesepatients.The results were expressed with " "by SPSSware,statistic analysis was performed with T test to examineintergroup deviation. When p<0.05 it was considered statisticallysignificant. Results:All the patients in these groups had nodifference in basic information.BP and HR of group T had minordecrease and there was no significant deviation after induction.BPof group C decreased significantly but HR did not.There was nosignificant deviation for other times .BIS,HRV of these two groupshad no significant difference,but MAC had differences.Theconsumption of midazolam in group T was more than that in groupC but the intermittent time for additional Fentanyl was longer andthe dosage was less and the consumption of Enflurane was also lessthan that in group C .There was no significantly differencestatistically in the recovery time of breath and the trachealextubation time and state.The patients of group T were more stableduring recovery than group C.1/3 patients of group C came torestless.Conclusion Target-controlled infusion is one of intravenousinjection way which is automatically adjusted according toobjective or target concentration by computer connected toinjective pump so as to control or maintain anesthesiadepth .TCI,as a way for anesthesic drug iv. is not always controlledby computer.Anesthesian can adjust the target concentrationaccording to the clinic need to stablize the anesthesia.TCImidazolam is used to control target concentration to get the stableanesthesia depth by computer in general anesthesia and it candecrease the fluctuation of the respiration and circulation withchange of the concentration in blood. It is quick and stable toinduce by TCI midazolam according to effective concentration andit is convenience to be used by computer.The consumption of othermedicine can be decreased and the intermittent time of additionalFentanyl is extended by TCI midazolam.It can obviously decreaseMAC and there is no statistic difference in the recovery time andthe tracheal extubation time and state.