| Part I Study on the induced dose of sufentanil in total intravenous anesthesia in patients at different altitudesObjective: To explore the effect of altitude on the induced dose of sufentanil in patients with total intravenous anesthesia.Methods: Patients scheduled for elective surgery under total intravenous anesthesia were selected from May 2021 to February 2023 in Yuanjiang County people’s Hospital(altitude 380m),Kaiyuan people’s Hospital(altitude 1050m),Yunnan first people’s Hospital(altitude 1891m),Lijiang people’s Hospital(altitude 2400m)and Diqing people’s Hospital(altitude 3459m).A total of 130 patients were enrolled according to the improved Dixon sequential method,according to the altitude of the hospital,the patients were divided into group a(n=25),group b(n=26),group c(n=27),group d(n=25)and group e(n=27).Anesthesia induction was performed on the patient under the monitoring of the multifunctional anesthesia depth monitor.Wavelet index(WLi),pain threshold index(PTi),mean arterial pressure(MAP)and heart rate(HR)were observed and recorded before administration(t1),before endotracheal intubation(t2)and after endotracheal intubation immediately(t3),1 min(t4)and 3 min(t5).The dosage of sufentanil was also recorded.Results:(1)Comparison of general condition: There was no significant difference in preoperative general condition among the five groups(P>0.05).(2)Comparison of the changes of WLi and PTi during anesthesia induction: The WLi and PTi at t2,t3,t4 and t5 in the five groups were lower than those at t1(P<0.05),and the level at t3 was higher than that at t2.The PTi at t3,t4 and t5 in patients with positive intubation reaction was significantly higher than that in patients with negative intubation reaction(P<0.05),but there was no significant difference in WLi(P>0.05).(3)Comparison of the changes of MAP and HR during anesthesia induction: There was no significant difference in the changes of MAP and HR among the five groups at different times(P>0.05).The MAP and HR of the patients with positive intubation reaction were significantly higher than those of the patients with negative intubation reaction in the same group(P<0.05)at t3,t4 and t5,and the highest at t3(P<0.05).(4)Sufentanil induction dose and correlation analysis with altitude: There was no significant difference in ED50 and 95%CI induced by sufentanil among the five groups(P>0.05),but it was significantly correlated with the change of altitude(P<0.01).Conclusion: There was no significant difference on induced ED50 and 95%CI of sufentanil among the patients in 5 different areas from altitude 380 m to 3459 m during total intravenous anesthesia,but the induced dose of sufentanil was significantly correlated with the change of altitude.Part II Study on the induction and maintenance of propofol and maintenance dose of remifentanil during total intravenous anesthesia in patients at different altitudesObjective: To explore the effect of altitude on the induced or maintained dose of propofol and remifentanil in patients with total intravenous anesthesia.Methods: Three hundred patients scheduled for laparoscopic cholecystectomy under total intravenous anesthesia were selected from May 2021 to February 2023 in Yuanjiang County people’s Hospital(altitude 380m),Kaiyuan people’s Hospital(altitude 1050m),Yunnan first people’s Hospital(altitude 1891m),Lijiang people’s Hospital(altitude 2400m)and Diqing people’s Hospital(altitude 3459m),according to the altitude of the hospital,the patients were divided into group A,group B,group C,group D and group E,with 60 patients in each group.Anesthesia induction and maintenance were carried out under the monitoring of multi-functional anesthesia depth monitor.WLi,PTi,Pulse oxygen saturation(Sp O2),MAP and HR were observed and recorded before administration(T1),before endotracheal intubation(T2),after endotracheal intubation(T3),skin incision(T4),extract gallbladder(T5)and remove endotracheal tube(T6).Recorded the propofol induction dose,propofol and remifentanil maintenance time and dose,induction time of anesthesia,operation time and recovery time of patients,patients’ preoperative red blood cell count(RBC),hemoglobin(Hb),total protein(TP),albumin(ALB).The adverse reactions such as intraoperative hypotension,arrhythmia,adverse body movement and postoperative complications such as nausea,vomiting,respiratory depression,delayed awakening and intraoperative awareness were also recorded.Results:(1)Comparison of general condition: There was no significant difference in preoperative general condition among the five groups(P>0.05).(2)Comparison of preoperative RBC,Hb,ALB,TP: The preoperative RBC and Hb of the five groups increased gradually with the increase of altitude.There was no significant difference in RBC and Hb in group A,B and C(P>0.05),but the RBC and Hb in group D and E were higher than those in group A,group B and group C(P<0.01).(3)Respiratory and circulatory changes: The Sp O2 of five groups at T1 time decreased with the increase of altitude(P<0.05),there was no significant difference among group A,group B and group C(P>0.05),but that in group D and E was significantly lower than that in group A,group B and group C(P<0.05).The MAP of the five groups at T2,T3,T4 and T5 was lower than that at T1 and T6(P<0.05),and the level at T3 was higher than that at T2(P<0.05).The HR of the five groups at T2,T4 and T5 was lower than that at T1(P<0.05),and there was no statistical difference at T3 and T6 compared with T1(P>0.05).There was no significant difference in MAP and HR at different time among the five groups(P>0.05).(4)WLi and PTi: The WLi and PTi of the five groups decreased at T2-T6 compared with T1(P<0.05),and rebounded at T6.(P<0.05).There was no significant difference in WLi and PTi among the five groups at the different time(P>0.05).(5)Propofol induction dose,propofol maintenance dose,remifentanil maintenance dose and their correlation analysis with altitude: With the increase of altitude,the induction and maintenance dose of propofol decreased gradually(P<0.05),and the maintenance dose of remifentanil increased gradually(P<0.05).Propofol induction,maintenance and remifentanil maintenance dose were all correlated with altitude in five groups(P<0.01),The fitting equations between the dosage of propofol and remifentanil with altitude are induced dose of propofol=7.36e-113-4.22e-7 2+5.51e-4 +1.86,maintenance dose of propofol=-2.81e-9 3+1.76e-5 2-4.20e-2 +112.02,maintenance dose of remifentanil=2.263e-12 3-1.2e-8 2+3.156e-5 +0.169.(6)Time of anesthesia and operation: The induction time and awakening time of general anesthesia in the five groups decreased with the increase of altitude(P<0.01),but there was no significant difference in operation time(P>0.05).(7)Intraoperative adverse reactions and postoperative complications: There was no significant difference in intraoperative hypotension,arrhythmia,dyskinesia,postoperative nausea,vomiting,respiratory depression,delayed awakening and intraoperative awareness among the five groups.(P>0.05).Conclusion: Total intravenous anesthesia was performed in 5 different areas from 380 m to 3459 m above sea level.The dosage of propofol and remifentanil was significantly correlated with altitude.The induction and maintenance dose of propofol decreased with the increase of altitude,while the maintenance dose of remifentanil increased with the increase of altitude. |
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