Effect Of Precise Anesthesia On Perioperative Cellular Immune Function In Robot-assisted Laparoscopic Radical Prostatectomy

AIM:To evaluate the effect of precise anesthesia on perioperative cellular immune function in robot-assisted laparoscopic radical prostatectomy.METHODS:Fifty-six patients with elective robot-assisted laparoscopic radical prostatectomy?RARP?,age from 40years old to 79 years old,grade of ASAI-III,were randomized into two groups:precision anesthesia group?group A?and routine anesthesia group?group B?.Each group concludes twenty-eight cases.When the group A was induced,propofol was controlled by value-targeted infusion of 40-60.Muscular loosening agent cis-atracurium was closed-loop infusion through the monitoring device of muscle relaxation monitoring,and monitoring and management were used to control fluid input by vigileo.The patients in the group B were treated by anesthesiologists.Experience and the specific circumstances of the implementation of anesthesia management.?40°,head low height?position is applied to each group of patients.Time point of each observation index as following:before anesthesia?T0?,after anesthesia induction but before the operation?T1?,one hour after anesthesia?T2?,two hours after surgery?T3?,twenty-four hours postoperatively?T4?,and seventy-two hours postoperatively?T5?.Peripheral arterial blood at each time point were collected,flow cytometry was used to detect blood T cell subsets?the value of CD3⁺?CD4⁺?CD8⁺?CD4⁺/CD8⁺?FoxP₃-Treg and NK cell values?,The values of MAP?HR?PpeakPplat were also recorded at each times.Analyze the change of each time point and each index compared with the time before anesthesia?T0?,recording the dose of propofol,sufentanil,Refentanil,cis-atracurium.RESULTS:1.The preoperative basic condition of the patient:There was no significant difference in preoperative basic clinical information,operation time,and duration of anesthesia between the patients in the group and the group?P>0.05?.The fluid volume in the group was less than that in the group,and the difference was statistically significant?P<0.05?.2.,The change of vital signs:the time group was significantly higher than that of the group?P<0.05?,and the group had different time points and fluctuations;compared with the time,the time group was significantly higher?P<0.05?;At the time of comparison,there was no difference between the groups of^P>0.05.3.The changes of intraoperative airway pressure:Ppeakt and Pplat values were significantly higher in each group than in the same time?P<0.05?,and Ppeak and Pplat in group B were significantly higher than those in group A?P<0.05?.4.The doses of propofol and cis-atracurium in the group were significantly lower than those in the group?P<0.05?.The doses of sufentanil and remifentanil and the two groups were not statistically significant?P>0.05?.5.Comparison of the cellular immunity related indexes at each time point in the two groups.?1?After anesthesia induction but before operation?T1?;Compared with T0,A group increased CD4+and CD4+/CD8+?P<0.01,P<0.05?,CD4+and NK cells in B group all decreased?P<0.01,P<0.05?,but there was no significant change in two groups.Compared with group A,CD4+was significantly increased?P<0.01?.?2?.The intraoperative 1h?T2?:Compared with T0,CD4+,CD8+,CD3+CD4+/CD8+and NK cells were significantly decreased in group B?P<0.01,P<0.05?,the values of CD4+,CD8+,CD3⁺,CD4⁺/CD8⁺were decreased in group A,but there was no statistical significance about them?P>0.05?,no change in the level of Treg cells?P>0.05?.The comparison between two groups about the values ofCD4⁺,NK cells were increased?P>0.05?.?3?2h after operation,?T3?:Compared with T0,CD3+and CD4+in group A and B were significantly decreased?P<0.05,P<0.05?,and CD4+/CD8+in group B decreased,but there was no significant change in two groups.There was no difference between group A and B?P>0.05?.?4?.24h after operation?T4?:Compared with T0,all the indexes of the two groups recovered close to the level of T0 before anesthesia,and the difference was not statistically significant?P>0.05?.Compared with group A,CD4+was significantly increased?P<0.01?.?5?72h after operation?T5?:Compared with T0,CD4+in group A increased?P<0.05?,and Treg level in group A and B were all decreased significantly?P<0.01?.All the other indexes of the two groups were restored to the level before anesthesia,and the difference was not statistically significant?P>0.05?.CONCLUSION:In robotic-assisted laparoscopic radical prostatectomy?RARP?,precise anesthesia management can significantly reduce intraoperative hemodynamics and airway pressure fluctuations,reduce general anesthetic dosage,and reduce the general anesthesia for cellular immune inhibition in patients.