The Impact Of Different Doses Of Sufentanil On Propofol Tci Target Effect Concentration

Objective To investigate the effects of different sufentanil doses on propofol target controlled infusion(TCI) when the sedative depth of anesthesia was maintained at bispectral index(BIS)45-55 and evaluate sufentanil potency ratio and its optimal concentration for hemodynamic stability and recovery features.Methods Forty-five ASA grade I or II patients , scheduled for elective abdominal surgery, were randomly divided into three groups with 15 patients in each group: group I fentanyl;group II a low dose of sufentanil(potency ratio =10);group III a large dose of sufentanil(potency ratio =7). All the patients underwent total intravenous anesthesia(TIVA). The patients were received intramuscular Phenobarbital( 0.1g) and scopolamine (0.3mg) 30 min before induction.Anesthesia was induced with midazolam 0.05mg · kg^-1,fentanyl(3μg/kg) or sufentanil(0.3μg/kg or 0.45μg/kg) and propofol TCI(C=2μg/mL) started instantly.Tracheal intubation was facilitated with vecuronium 0.12 mg · kg^-1.After intubation anesthesia was maintained with fentanyl (2μg · kg^-1 · h^-1,group I ),sufentanil(0.2μg · kg^-1 · h^-1,group II)or sufentanil(0.3μg · kg^-1 · h^-1,group III)combined with propofol TCI.MAP,HR,SpO₂, P_ETCO₂,BIS and effective concentration of propofol TCI were continuously monitored during anesthesia.BIS was maintained at 45-55 during maintaince of anesthesia.Vasoactive drugs, recovery time and the total doses of propofol were recored.Results The three groups were comparable with respect to age,sex,body weight,duration of anesthesia.There were no significant differences in MAP,HR,BIS during operation among three groups.When BIS was maintained at 45-55,the effect-site concentration of propofol TCI was 2.2μg · ml^-1(group I ),2.1μg · ml^-1(group II)and1.7μg · ml^-1(group III) respectively. Comparing group I, the effect-site concentration of propofol TCI was decreased significantly by 22.7%( P < 0. 05) in group III.The total doses of propofol was 5.1mg · kg^-1 · h^-1,4.8 mg · kg^-1 · h^-1 and 4.0 mg · kg^-1 · h^-1 respectively in three groups,significantly lower in group IIIthan that in group I (P<0.01) Hypertention were more frequent with group I (7 cases)and II(5 cases) than that in group III(1 case)during operation.And no statistical changes occurred in recovery time( P > 0.05) .The number of restlessnesswas 2,1,0 respectively after the end of the operation in three groups.Conclusions At the same depth of anesthesia(BIS=50±5),the effect-site concentration of propofol TCI in group HI comparing group I was greatly reduced when combined with TCI propofol. Comparing with a low dose of sufentanil;,a large dose of sufentanil has less cardiovascular effects during tratheal intubation less hemodynamic changes during operation and didn't prolong recovery time when combined with propofol TCI in total intravenous anesthesia.