Applied Research Of Surgical Pleth Index Combined With Entropy Index Monitoring During Enhanced Recovery After Surgery

Objective:By observing the difference between open-loop target controlled infusion of total intravenous anesthesia under the guidance of Surgical Pleth index(SPI)combined with Entropy and traditional methods,to study the effect of this multimodal monitoring on patients of shoulder arthroscopic surgery under general anesthesia,and to explore the clinical significance of precision anesthesia in Enhanced Recovery After Surgery(ERAS).Methods:Sixty patients undergoing shoulder arthroscopy were randomly divided into two groups according to the order of admission,group A(standard monitoring group,30)and group B(joint monitoring group,30).Standard monitoring was used in group A,and group B was monitored by SPI and Entropy based on standard monitoring.All enrolled patients were anesthetized and monitored according to standardized protocols.The adjustment of remifentanil and propofol in group A were based on blood pressure,heart rate,tearing,and body movement.Group B adjustment were based on SPI and State Entropy(SE).SPI,SE,heart rate(HR),mean arterial pressure(MAP),and nasopharyngeal temperature(NT)at the time of TO to T7 during surgery were recorded;The amount of propofol and remifentanil used,the frequency of regulation of the two drugs,the number of patients with circulatory adverse events,the amount of vasoactive drugs used,and the time proportion of hemodynamic target value were recorded;The recovery time of spontaneous breathing,the time of instruction opening eyes,the time of extubation and the recovery time of orientation in both groups were recorded;The modified Aldrete score and Ramsay score at T8～T11,the UCLA shoulder score and the NRS score at T12～T17 were recorded;The first time out of bed,the time of eating,the length of stay in hospital,the cost of hospitalization,the satisfaction of the patient and the complications were recorded.Results:There was no significant difference in general data between the two groups(P>0.05).There were significant differences in HR and MAP in the two groups at the time of T0～T7(P<0.05).The changes of SPI and SE at the time of T0～T7 in the two groups were significant(P<0.05),but the fluctuation of circulation in group B was more stable.The number of patients with adverse circulatory events and the dosage of vasoactive drugs in group B were less than those in group A(P<0.05),while the time proportion of hemodynamic target value was greater than that in group A(P<0.05).The dosage of propofol and remifentanil in group A were significantly higher than in group B(P<0.05),and the number of drug regulation was less than in group B(P<0.05).The awake and extubation time of group B were shorter than group A(P<0.05).The modified Aldrete score and Ramsay score at multiple time points were better than group A(P<0.05).The UCLA scores in group B at T14 and T15 were higher than those in group A(P<0.05).The NRS scores in group B at T14,T15 and T16 were lower than those in group A(P<0.05).There was no significant difference in postoperative complications between the two groups(P>0.05).The patients in group B had earlier time to get out of bed and eat earlier than group A,and hospitalization days and hospitalization expenses were less than group A.(P<0.05).The satisfaction score of group B was higher than that of group A(P<0.05).Conclusions:The multimodal monitoring of SPI combined with Entropy can effectively monitor the analgesia and sedation depth of general anesthesia,reduce the dosage of remifentanil and propofol during the operations,and facilitate early rehabilitation of patients undergoing general anesthesia for shoulder arthroscopy without increasing postoperative complications.In addition,the intraoperative circulation is more stable.But there is no obvious advantage in the medium and long term recovery.