The Research Of Reducing Nociception Stimulation Induced By Tracheal Intubation With Index Of Consciousness Monitoring

Objective Tracheal tube is widely used in clinical anesthesia as a effective ventilator device,which can maintain the airway unobstructed and gas exchange.Meanwhile,tracheal intubation is also a severely noxious stimulation,which can cause severe symptoms of sympathetic excitement such as increased blood pressure and heart rate,especially in the elderly and patients with cardiovascular and cerebrovascular diseases,which may lead to serious cardiovascular and cerebrovascular adverse events.Sufentanil as a potent opioid,is widely used in anesthesia-induced tracheal intubation and anesthesia maintenance.Sufentanil can effectively inhibit the stress response to tracheal intubation at a certain dose.Analgesic depth monitoring can guide the use of intraoperative analgesic drugs,reduce opioid consumption,and reduce the adverse reactions of anesthesia,but the monitoring of analgesic depth during tracheal intubation is rarely reported.Index of Consciousness 1 can be used to monitor the depth of sedation,while Index of Consciousness 2 can be used to monitor the depth of analgesia.The purpose of this study was to observe the value of consciousness index 2 during tracheal intubation induced by different doses of sufentanil combined with propofol target-controlled infusion,to verify the effectiveness of monitoring the depth of analgesia during intubation,to explore the appropriate value of anesthesia 2 during intubation,and to explore the relationship between Index of Consciousness 1 and BIS during intubation.To further understand the characteristics of Index of Consciousness,so as to guide the use of drugs during tracheal intubation,to ensure patient safety.Methods 60 cases of patients undergoing elective surgery,aged 19-57 yr,were divided into 3 groups(n=20 each)using a random number table.Anesthesia was induced with target controlled infusion of propofol(Marsh model)using a initial effect site concentration of 2?g/ml guided with BIS values ranged from 40 to 60.A dosage of 0.2?g/kg sufentanil group(group S1),0.4?g/kg sufentanil group(group S2)and 0.6?g/kg sufentanil group(group S3)respectively and 0.8mg/kg rocuronium were injected when BIS values were achieved below 60.Direct vision tracheal intubation was performed 3 min later.BIS,HR,MAP and Io C1? Io C2 were recorded at this following time points:10 min after entering the operation room(T1),after induction and before using sufentanil(T2),3 min after using sufentanil(T3),1 min after intubation(T4),3 min after intubation(T5),5 min after intubation(T6).Hypertension,hypotension,tachycardia,bradycardia,the amount dosage of propofol and rocuronium were recorded during induction as well.Results With the increase of sufentanil dosage,Io C2 in group S2 and S3 decreased(P<0.05).The incidence of sinus tachycardia in group S1 was significantly increased(P<0.05).The correlation coefficients of BIS and Io C1 in S1,S2 and S3 groups were 0.784,0.746 and 0.748,respectively.There was no difference between three groups.The incidence of hypotension in group S3 was significantly higher(P<0.05).Io C2 was negatively correlated with sufentanil dose(r=-0.417).Conclusions When different doses of sufentanil were used,the consistency between Io C1 and BIS is fine,which can effectively reflect the depth of sedation.The endotracheal intubation response can be effectively suppressed when the Io C2 value is 42±8 with infusion of 0.4?g/kg sufentanil.Io C2 can be used to monitor the depth of analgesia in tracheal intubation and to prevent the intubation response,which has clinical practical value.