Application of propofol closed-loop target-controlled infusion for different anesthesia depth combined with nerve block in elderly artificial hip replacement / 中国医师杂志

Objective:To investigate the effect of propofol closed-loop target-controlled infusion system in controlling the bispectral index (BIS) at different levels during artificial hip replacement in the elderly under general anesthesia combined with nerve block on postoperative delirium, postoperative pain and intraoperative circulation control.Methods:From October 2017 to May 2019, 95 elderly patients with elective unilateral artificial hip replacement were selected from Xiangya Hospital of Central South University. They were randomly divided into light anesthesia group (48 cases) and deep anesthesia group (47 cases). Under general anesthesia combined with nerve block, the target BIS value of propofol closed-loop target-controlled infusion in the light anesthesia group was set to 55±5, and the target BIS value of the deep anesthesia group was 45±5. The incidence of postoperative delirium and postoperative pain visual analogue scale (VAS) score were observed. The changes of hemodynamics, intraoperative vasoactive drug use, propofol dosage and intraoperative BIS value at different time points were compared between the two groups.Results:There was no significant difference in the incidence of postoperative delirium and the VAS score of postoperative pain between the two groups ( P>0.05). The average intraoperative BIS and the ratio of intraoperative BIS>50 in the light anesthesia group were higher than those in the deep anesthesia group ( P<0.001), and the intraoperative propofol consumption was lower than the deep anesthesia group ( P<0.001); In the light anesthesia group, the arterial systolic blood pressure level after laryngeal mask implantation and skin incision during the induction period of general anesthesia was higher than that in the deep anesthesia group ( P<0.05), and the number of cases of phenylephrine use in the light anesthesia group was lower than that of the deep anesthesia group ( P<0.05). Conclusions:When using general anesthesia combined with nerve block for the elderly artificial hip replacement, the different control levels of BIS in the closed-loop target-controlled infusion of propofol have no effect on postoperative pain and postoperative delirium, but the intraoperative BIS value controlled at a lower level is related to the suppression of the patient′s hemodynamics and brings more propofol consumption.

Comparison of anesthesia effects between closed / 中南大学学报(医学版)

OBJECTIVES@#Bispectral index (BIS) can reflect the depth of propofol sedation. This study aims to compare the anesthetic satisfaction, anesthetic dose, and hemodynamic changes between closed-loop target controlled infusion (CLTCI) and open-loop target controlled infusion (OLTCI) during abdominal surgery.@*METHODS@#From December 2016 to December 2018, 70 patients undergoing abdominal surgery under general anesthesia were selected in Beijing Hospital, including 51 males and 19 females, at the age from 49 to 65 years old. They were classified as grade I-II by the American Society of anesthesiologists (ASA) and were randomly divided into the CLTCI group and the OLTCI group (@*RESULTS@#In the induction stage, the percentage of adequate anesthesia time in the CLTCI group was higher than that in the OLTCI group, and the percentage of deep anesthesia time in the CLTCI group was significantly lower than that in the OLTCI group (both @*CONCLUSIONS@#Compared with propofol OLTCI, anesthesia with propofol CLTCI under BIS guidance can maintain a more appropriate depth of anesthesia sedation and more stable hemodynamics.

Hemodynamic effects of open-loop and closed-loop target controlled infusion of propofol and fentanyl for general anesthesia induction / 上海第二医科大学学报

Objective To observe the hemodynamic effects of open-loop target controlled infusion (OLTCI) and closed-loop target controlled infusion (CLTCI) of propofol and fentanyl for general anesthesia induction. Methods Twenty-four female patients with ASA grade I-II who were performed thyroidectomy were randomly allocated into two groups: OLTCI group and CLTCI group(n=12). In OLTCI group, anesthesia induction and maintenance were performed with propofol and fentanyl at the target concentrations of 3 ?g/mL and 3 ng/mL, respectively. In CLTCI group, double CLTCI were performed. Titrations of propofol and fentanyl were guided with bispectral index (BIS) and product of systolic pressure and heart rate (HR). Initiative concentrations of this closed-loop system were 3 ?g/mL and 3 ng/mL, step-up or step-down concentrations were 0.5 ?g/mL and 0.5 ng/mL, and the highest concentrations were 6 ?g/mL and 5 ng/mL, respectively. HR, mean arterial pressure (MAP), HR variability, BIS value and the dosages of propofol and fentanyl in various time of the two groups were recorded. Results One min after intubation and simulative incision stimulation, BIS value of both groups were increased, but the BIS value in CLTCI group was less increased than OLTCI group(P