The Application Of Closed-loop Infusionsystem For Hepatic Partial Resection

Objective To approach the feasibility, safety and superiority of closed-looptarget controlled infusion of propofol in partial liver resection.Methods Sixty patients scheduled for hepatic partial resection wererandomly divided into two groups with30cases for each. Group O,opened-loop target controlled infusion of propofol, using the manual adjustmentof propofol target controlled concentration based on monitoring of BIS, BIS wasmaintained between45to55. Group C, closed-loop target controlled infusion ofpropofol, using the automatic adjustment of propofol target controlledconcentration based on monitoring of BIS, BIS was maintained between45to55. MAP, HR and BIS were recorded at quiet time (T0), loss of consciousness(T1), intubation (T2), intubation success (T3),1min after intubation (T4),3minafter intubation (T5),5min after intubation (T6), skin incision (T7), exploration(T8), cut the tumor (T9), and time of wound closure (T10). Recorded theanesthesia duration, recovery time, extubation time. Calculated the total usage of propofol and remifentanil. Statistics on the use of atropine, ephedrine, urapidil,nitroglycerin and adjusted fequency of target controlled concentration ofpropofol and remifentanil during perioperative period. The amount of bleeding,the statistics of perioperative blood transfusion, infusion and urine volume.Observed and recorded the agitation, chills, nausea and vomiting, and incidenceof intraoperative awareness in these patients during postanesthesia. Theevaluation system indexes included the global score (GS), the performance error(PE), the median performance error (MDPE), inaccuracy or the medianabsolute performance error (MDAPE), the wobble (Wobble),the full time ofanesthesia (40<BIS<60).Results There was no significant differences in two groups of patients withgender, age, height, weight, BMI,(P>0.05); Two groups of patients in T3-T6BISvalue and T0value of BIS versus T1-T6to compare the differences werestatistically significant (P<0.05); The two groups had statistical significance inpatients with T1-T6and T0MAP between the two groups (P<0.05); The twogroups had statistical significance in patients with T7-T9at the time of the MAPbetween the two groups (P<0.05); Lost of consciousness time differencebetween the two groups has statistical significance (P<0.05); No statisticallysignificant average amount of propofol and remifentanil group two and theaverage concentration difference (P>0.05). There was significant differencebetween the two groups (P<0.05) propofol control times. Two groups ofremifentanil regulating times had no significant difference (P>0.05); Twogroups of patients with adequate anesthesia time (40<BIS<60) was statisticallysignificant, MADPE score, GS score difference (P<0.05); The use of drugs inthe two groups and liquid intake and output, and postoperative complicationswere not significant. Conclusion Closed-loop group is superior to the Opened-loop group.Adverse reactions associated with the test system of surgery does not appear,indicating that BIS monitoring under CONCERT-CL used in partial hepaticresection in perioperative is safe.