| Objective:In this study,BIS monitoring is used for general anesthesia to explore the maintenance dose of propofol for the elderly and non-elderly patients under total intravenous anesthesia,and to compare whether there is a statistical difference between the two,so as to provide a reference for the application of propofol in anesthesia for the elderly.Methods:156 patients undergoing elective surgery under general anesthesia were randomly selected between August 2017 and April 2018 in the Second Hospital of Jilin University.The patients needed to fulfil the following criteria: age,20~85 years of age;weight,40~90 kg;and ASA grade II~III.The patients were divided into two groups according to age: the elderly group(group O,patients of 65~85 years of age)and the non-elderly group(group Y,patients of 20~64 years of age).All patients were fasted before surgery and 1 mg of penehyclidine hydrochloride was given before induction of anesthesia.Rapid induction of total intravenous anesthesia was used in both groups: midazolam 0.05 mg/kg,fentanyl citrate 4.0 ? g/kg,etomidate 0.2 mg/kg,benzenesulfonate cis atracurium 0.15 mg/kg.Anesthesia maintenance: both groups were treated with fentanyl citrate 2.0 ? g/kg and benzenesulfonate cis atracurium 0.05 mg/kg at the beginning of operation.Then,fentanyl citrate 2.0 ?g/kg was added every 1 hour;benzenesulfonate cis-atracurium 0.05 mg/kg was added every 40 minutes,and the muscle relaxant should be stopped about 1 hour before the end of the operation.The injection rate of remifentanil was 15 ? g/(kg·h),and the initial pump velocity of propofol was 5 mg/(kg·h),and then adjusting dosage to maintain a BIS value of 40~60.At the end of the operation,the infusion of anesthetic drugs was stopped instantly.When the patient awoke,spontaneous respiration was resumed,and the extubation conditions were satisfied,the tracheal catheter was removed and the patient was placed in the post-anesthesia care unit(PACU).At the same time,the following indicators were recorded in both groups:(1)Sex,height,weight,ASA grade,operation time,anesthesia time,intraoperative awareness,type of operation,spontaneous respiratory recovery time,extubation time.(2)The number of cases suffering hypertension,heart disease,diabetes and cerebrovascular disease before operation.(3)Mean artery pressure(MAP),heart rate(HR),Oxygen saturation(Sp O2)and BIS were recorded at the time of room entry(T0),preinduction(T1),intubation(T2),beginning of operation(T3),end of operation(T4)and extubation(T5).(4)Intraoperative use of vasoactive drugs.(5)Intraoperative infusion volume and urine volume.(6)maintenance dose of propofol(B),maintenance dose of remifen(R),maintenance dose of fentanyl(F)and maintenance dosage of phenanthrene atracurium(H).Results:1.There was no significant difference in other general data(P>0.05)between the two groups except ASA grade(P<0.05).2.There was a statistically significant difference in the incidence of preoperative special cases between the two groups(P<0.05).3.There were significant differences in MAP at T0,HR at T0,T1,T2,and BIS at T2 between the two groups(P<0.05).There was no significant difference in MAP,HR,Sp O2,BIS between the two groups at other time points(P>0.05).4.There was no significant difference in the use of other vasoactive drugs(P> 0.05)between the two groups except ephedrine(P< 0.05)..5.There was no significant difference in infusion volume and urine volume between the two groups(P>0.05).6.The optimal maintenance dose of propofol for the elderly is(B)was 3.37±0.77mg/(kg·h),which was significantly lower than that in the Y group(3.70±0.86 mg/(kg·h)).There was no significant difference in R?H?F between the two groups(P>0.05).Conclusions:Under the BIS monitoring,the total dose of propofol in the elderly with intravenous anesthesia should be reduced and the dose recommeded for the elderly should be 3.37±0.77 mg/(kg·h)which is lower than the recommended dosage of 4~12mg/(kg·h)in the instructions and significantly lower than 3.70 ± 0.86 mg /(kg·h)in non-elderly. |
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