Background There are few studies to assess whether the effect-site concentration of propofol can predict anesthetic depth during the target-controlled infusion （TCI） induction in elderly patients. This study aimed t...Background There are few studies to assess whether the effect-site concentration of propofol can predict anesthetic depth during the target-controlled infusion （TCI） induction in elderly patients. This study aimed to evaluate the relationship between effect-site concentration of propofol and depth of anesthesia during the TCI induction in elderly patients. Methods Ninety patients （60-80 years） with an American Society of Anesthesiologists （ASA） physical status of 1-3, undergoing scheduled abdominal and thoracic surgery under general anesthesia were randomly allocated into one of three groups, Group S1, S2 and S3 （30 patients in each group）. The patients in Group S1 received propofol with a target plasma concentration of 4.0 pg/ml; patients in Group S2 received propofol with an initial target plasma concentrations of 2.0 IJg/ml that was raised to 4.0 pg/ml 3 minutes later; patients in Group S3 received an infused scheme of 3 steps; starting from a target plasma concentration of 2.0 pg/ml that was increased stepwised by 1 pg/ml until a target plasma concentration of 4.0 pg/ml was achieved, the interval between the two steps was 3 minutes. When an Observer＇s Assessment of Alertness/Sedation （OANS） score of 1 was achieved, remifentanil （effect-site concentration （Ce） of 4.0 ng/ml） and rocuronium 0.9 mg/kg were administered. Tracheal intubation was started 2 minutes after rocuronium injection. Changes of propofol Ce, blood pressure （BP）, heart rate （HR）, and bispectral index （BIS） were recorded. Results When an OAA/S score of 1 was achieved, Ce of propofol were （1.7±0.4） pg/ml, （1.9±0.3） pg/ml, （1.9±0.4） pg/ml and the BIS values were 64±5, 65±8, and 62±8 in Groups S1, S2 and S3. Before intubation, Ce of propofol was （2.8±0.2） pg/ml, （2.8±0.3） pg/ml, （2.7±0.3） pg/ml, and the BIS values were 48±7, 51±7, and 47±5 in Groups S1, S2 and S3. By linear regression analysis, a significant correlation between Ce of propofol and BIS values was found （展开更多
目的观察BIS指导静脉全身麻醉对老年合并中重度高血压膝关节置换手术患者术后谵妄（postoperative delirium，POD）的影响。方法选择老年合并中重度高血压拟行择期单侧全膝关节置换手术患者80例，年龄63．80岁，ASA分级Ⅱ、Ⅲ级，纽约...目的观察BIS指导静脉全身麻醉对老年合并中重度高血压膝关节置换手术患者术后谵妄（postoperative delirium，POD）的影响。方法选择老年合并中重度高血压拟行择期单侧全膝关节置换手术患者80例，年龄63．80岁，ASA分级Ⅱ、Ⅲ级，纽约心脏病协会（NYHA）心功能分级Ⅰ、Ⅱ级，术前简易智力量表（Mini-Mental State Examination，MMSE）评分≥23分，采用随机数表法分为两组（每组40例）：经验麻醉组（E组）和BIS监测组（B组）。B组根据术中BIS值调整麻醉深度，E组根据临床体征和麻醉医师经验判断麻醉深度。记录两组患者诱导前（T0）、诱导后3min（T1）、上止血带前（T2）、上止血带后30min（T3）、松止血带前（T4）、松止血带后（T5）的血流动力学指标，并记录两组呼吸恢复时间、睁眼时间、拔管时间、PACU驻留时间、麻醉药物用量、血管活性药物用量以及麻醉相关并发症（躁动、苏醒延迟、术中知晓、术后恶心呕吐）发生情况，术后采用谵妄评估量表（theConfusionAssessmentMethod，CAM）评估术后3d内POD发生情况。结果E组T1、T2时SBP分别为（112±9）、（103±7）mmHg（1mmHg=0．133kPa），TI时DBP为（66±7）mmHg，B组T1、T2时SBP分别为（119±11）、（108±9）mmHg，TI时DBP为（72±10）mmHg，与E组比较，B组．T1、T2时SBP和T1时DBP均高于E组，差异有统计学意义（P〈0．05）；B组丙泊酚用量[（322±49）mg]小于E组[（366±52）mg]，差异有统计学意义（P〈0．05）；B组呼吸恢复时间[（4．3±1．5）min]、睁眼时间[（5．7±1．4）min]、拔管时间[（10．5±2．5）min]、PACU驻留时间[（32±5）min]短于E组[（5．6±2．1）、（7．4±2．1）、（12．1±2．5）、（35±6）min]，差异有统计学意义（P〈0．05）；与E组比较，B组术后3dPOD总发生率（20．0％）明显低于E组（45．0％），差异有统计学意义（P〈0．05）。结论B展开更多
文摘Background There are few studies to assess whether the effect-site concentration of propofol can predict anesthetic depth during the target-controlled infusion （TCI） induction in elderly patients. This study aimed to evaluate the relationship between effect-site concentration of propofol and depth of anesthesia during the TCI induction in elderly patients. Methods Ninety patients （60-80 years） with an American Society of Anesthesiologists （ASA） physical status of 1-3, undergoing scheduled abdominal and thoracic surgery under general anesthesia were randomly allocated into one of three groups, Group S1, S2 and S3 （30 patients in each group）. The patients in Group S1 received propofol with a target plasma concentration of 4.0 pg/ml; patients in Group S2 received propofol with an initial target plasma concentrations of 2.0 IJg/ml that was raised to 4.0 pg/ml 3 minutes later; patients in Group S3 received an infused scheme of 3 steps; starting from a target plasma concentration of 2.0 pg/ml that was increased stepwised by 1 pg/ml until a target plasma concentration of 4.0 pg/ml was achieved, the interval between the two steps was 3 minutes. When an Observer＇s Assessment of Alertness/Sedation （OANS） score of 1 was achieved, remifentanil （effect-site concentration （Ce） of 4.0 ng/ml） and rocuronium 0.9 mg/kg were administered. Tracheal intubation was started 2 minutes after rocuronium injection. Changes of propofol Ce, blood pressure （BP）, heart rate （HR）, and bispectral index （BIS） were recorded. Results When an OAA/S score of 1 was achieved, Ce of propofol were （1.7±0.4） pg/ml, （1.9±0.3） pg/ml, （1.9±0.4） pg/ml and the BIS values were 64±5, 65±8, and 62±8 in Groups S1, S2 and S3. Before intubation, Ce of propofol was （2.8±0.2） pg/ml, （2.8±0.3） pg/ml, （2.7±0.3） pg/ml, and the BIS values were 48±7, 51±7, and 47±5 in Groups S1, S2 and S3. By linear regression analysis, a significant correlation between Ce of propofol and BIS values was found （
文摘目的观察BIS指导静脉全身麻醉对老年合并中重度高血压膝关节置换手术患者术后谵妄（postoperative delirium，POD）的影响。方法选择老年合并中重度高血压拟行择期单侧全膝关节置换手术患者80例，年龄63．80岁，ASA分级Ⅱ、Ⅲ级，纽约心脏病协会（NYHA）心功能分级Ⅰ、Ⅱ级，术前简易智力量表（Mini-Mental State Examination，MMSE）评分≥23分，采用随机数表法分为两组（每组40例）：经验麻醉组（E组）和BIS监测组（B组）。B组根据术中BIS值调整麻醉深度，E组根据临床体征和麻醉医师经验判断麻醉深度。记录两组患者诱导前（T0）、诱导后3min（T1）、上止血带前（T2）、上止血带后30min（T3）、松止血带前（T4）、松止血带后（T5）的血流动力学指标，并记录两组呼吸恢复时间、睁眼时间、拔管时间、PACU驻留时间、麻醉药物用量、血管活性药物用量以及麻醉相关并发症（躁动、苏醒延迟、术中知晓、术后恶心呕吐）发生情况，术后采用谵妄评估量表（theConfusionAssessmentMethod，CAM）评估术后3d内POD发生情况。结果E组T1、T2时SBP分别为（112±9）、（103±7）mmHg（1mmHg=0．133kPa），TI时DBP为（66±7）mmHg，B组T1、T2时SBP分别为（119±11）、（108±9）mmHg，TI时DBP为（72±10）mmHg，与E组比较，B组．T1、T2时SBP和T1时DBP均高于E组，差异有统计学意义（P〈0．05）；B组丙泊酚用量[（322±49）mg]小于E组[（366±52）mg]，差异有统计学意义（P〈0．05）；B组呼吸恢复时间[（4．3±1．5）min]、睁眼时间[（5．7±1．4）min]、拔管时间[（10．5±2．5）min]、PACU驻留时间[（32±5）min]短于E组[（5．6±2．1）、（7．4±2．1）、（12．1±2．5）、（35±6）min]，差异有统计学意义（P〈0．05）；与E组比较，B组术后3dPOD总发生率（20．0％）明显低于E组（45．0％），差异有统计学意义（P〈0．05）。结论B
