The Clinical Observation And Reseach Of The Extubation Memory Of The General Anesthesia Patients During Anabiosis

Objective:The paper is based on the postoperatively recovery of general anesthesia patients and to observe patients who undergo different sedation during the extubation period.The objective index for safety evaluation excludes BIS,RASS,STEWARD.Comparing between cardiovascular reaction,extubation time,extubation memory,recovery comfort,pain score and the incidence of postoperative complications.Study the related factors of extubation awareness and unpleasant recovery memories.Methods:Totally 101 patients undergoing surgery by general anesthesia,ASA I~II,were enrolled into this study.No obvious difference between the gender,ASA grade,weight,age,and operation time was found.These patients and their families were informed the experimental content and these patients have perfect preoperative examination,without obvious difficult airway,heart disease,mental illness and cognitive disorder.These patients were randomly divided into conventional extubation group,81 cases of group C,and BIS monitoring extubation group,20 cases of group E.Anesthesia induction was performed with midazolam,propofol,fentanyl andcisatracurium,respectively.The maintenance was performed with propofol,remifentanil and cisatracurium.Record the heart rate(HR)breathing rate(RR),systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),blood oxygen saturation(SPO2),electrical double frequency index(BIS),Richmond Agitation-Sedation Scale(RASS score),Steward score at before anesthesia(T0),the end of surgery(T1),separated from the mechanical ventilation(T2),extubation(T3),5 min after extubation(T4),10 min after extubation(T5)and the point of out of the ICU(T6).Record and fitting the anesthetic dosage and application time,calculate the blood drug concentration at T3.Record arterial blood gas analysis results at the point of out of the PACU(T6).Records ethnic,culture degree and profession information and so on.Records the anesthesia time,operation time,intraoperative blood loss,the lowest oxygen saturation within 1 h after extubation,Immediately test pain score and extubation memory score after extubation,and the symptom such as dizziness and vomiting.Before extubation,show a randomly picture to the patients and ask whether they remember after a day and then test pain score and extubation memory score again.Inquire whether a sore throat,cough,and sputum exists.Used SPSS17.0 statistical software for data collection to data,repeated measure analysis of variance for repeated measures of comparative data,comparison between groups use ANOVA.Results:(1)The discussion of heart rate,mean arterial pressure and the change of blood oxygen saturation between group C and E.Comparison between groups:MAP of group C at T2 to T4 is significantly higher than group E(P<<0.05);The HR is significantly higher than group E at T3(P<0.05);At the rest of the point,there is no statistically significant difference.Comparison in same group,there is no statistical significance in each time point about SPO2.TheMAP at T3 is significantly higher than the other points in group C,and the significant difference is with statistical significance(P<0.05).Comparing between T1,T2,T4-T6 and T0,there is no statistical significance(P>0.05).There is no statistical significance of MAP among group E(P>0.05).The HR between T3 and T0 has statistically significant difference in group C(P<0.05),but no statistical significance at the rest point(P>0.05).(2)RASS comparison between group C and E.Comparison between groups,RASS sore of group C was significantly higher than group E at T3 to T5(P<0.05),at the other points there is no significant decline in comparison(P>0.05).Comparison in same group,at T1,T2,T6,RASS score of both two groups have significant difference with T1(P<0.05).(3)Comparison between the group C and group E,the comparison of the arterial partial pressure of oxygen,arterial partial pressure of carbon dioxide,oxygenation index was not statistically significant.(4)Comparison among groups about extubation time,memory score,Prince-Henry score,postoperative analgesic and postoperative complications.Comparison between groups,the memory scores of group E are all significantly lower than group C(P<0.05),and comparing with group C,the extubation costs much less time(P<0.05).Comparing Prince-Henry score(includes the score on the day of surgery and score after a day of surgery)and postoperative analgesia between the two groups,differences had no statistical significance(P>0.05).The extubation complication of group E is more less than group C(P<0.05).(5)Basic data comparison between group C1 and C2.In addition to age,general data is similar between the two groups has no statistical significance(P>0.05),the age of group C2 is much more younger than C1(P<0.05).Anesthesia time,operation time and blood loss between the two groups was no statistically significant difference(P>0.05).The superficial surgery in group C2 is more than groupC1(P<0.05).(6)Comparison memory score and Prince-Henry score between group C1 and C2.Comparison between groups,Prince-Henry score between two groups has no statistically significant difference(P>0.05).Extubation time of group C2 is much more longer than C1(P<0.05).Postoperative analgesia between the two groups has statistically significant difference(P<0.05).(7)Comparison HR,MAP,SPO2 between group C1 and C2.Comparing among groups,MAP in group C1 and C2 has no statistically significant difference between T0 and other points(P>0.05).The HR at T3 point has statistically significant difference with T0(P<0.05),both of the two groups.The left points has no tatistically significant difference with T0(P>0.05).(8)RASS score comparison between group C1 and C2.Comparing among groups,The RASS score at T2 to T6 was significantly higher than T1(P<0.05),and it was close to zero at T6,each point compared with T1 difference had statistical significance(P<0.05).Comparing between groups,comparison difference have statistical significance at T5 point.there was no statistically significant difference at the other points(P<0.05).(9)Comparison between groups about extubation time,memory score,Prince-Henry score,postoperative analgesic and postoperative complications.Prince-Henry score differences between the two groups has no statistical significance(P>0.05).The extubation time of C1 was significantly shorter than C2(P<0.05).Comparison of the cases of postoperative analgesia has statistically significant difference between group C1 and C2(P<0.05).(10)Comparing about complications,except expectoration,there was no statistically significant difference(P>0.05).Compared with group C2,expectoration complication morbidity is significantly lower in group C1(P<0.05).Conclusion:(1)Remove the endotracheal tube when the BIS is between 65 to 75,the hemodynamic stability was stable,the extubation time was shorter,the patient had no long-term extubation memory,and had fewer complications.(2)Under normal circumstance,the factor of age and the extubation time can affect the extubation memory.