Effect of general anesthesia guided by bispectral index on postoperative sleep quality in elderly patients undergoing laparoscopic gastrointestinal tumor surgery / 中华麻醉学杂志

ABSTRACT

Objective:To evaluate the effect of general anesthesia guided by bispectral index (BIS) on postoperative sleep quality in elderly patients undergoing laparoscopic gastrointestinal tumor surgery.Methods:A total of 90 patients, aged 65-80 yr, with body mass index of 18-25 kg/m 2, of American Society of Anesthesiology physical status Ⅰ-Ⅲ, without preoperative sleep disorders, undergoing elective laparoscopic gastrointestinal tumor surgery, were divided into 3 groups ( n=30 each) using a random number table method: control group (group C) and different BIS value groups (group B1 and group B2). Combined intravenous-inhalational anesthesia was used.The BIS value in group B1 was maintained at 40-49, and the BIS value in group B2 was maintained at 50-60.The fluctuation range of heart rate and blood pressure was not more than 20% of the baseline, and vasoactive agents were administered when necessary in group C. Patient-controlled intravenous analgesia was performed with sufentanil, dezocine and palonosetron after surgery.When visual analog scale score>3, acetaminophen oxycodone tablets 5 mg was taken orally or flurbiprofen 50 mg was intravenously injected as rescue analgesic.At 1 day before surgery and 1, 3, 7 and 30 days after surgery, sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), postoperative sleep disorders were defined as PSQI scone≥6, and the development of postoperative sleep disorders was recorded.During the nighttime at 1 day before surgery and during the nighttime at 1, 2 and 3 days after surgery, sleep was monitored using body motion monitor (Honor Band 5). The intraoperative consumption of propofol and remifentanil and requirement for rescue analgesia at 48 h after surgery were recorded.The Quality of Recovery-15 (QoR-15) scores were measured at 1, 3 and 7 days after surgery.At 1 day before surgery and at 1 day after surgery, serum C-reactive protein concentrations were determined by immunoturbidimetry. Results:Compared with group C, PSQI scores were significantly decreased at 1 and 3 days after surgery, the incidence of sleep disorders was decreased at 3 days after surgery, sleep time, sleep score and proportion of rapid eye movement sleep time during the nighttime at 1 and 2 days after surgery were increased, intraoperative consumption of propofol was decreased, QoR-15 score at each time point after surgery was increased, and postoperative length of hospital stay was prolonged in group B2 and group B2 ( P<0.05). Compared with group B1, PSQI scores were significantly decreased at 1 and 3 days after surgery, sleep time, sleep score and proportion of rapid eye movement sleep time during the nighttime at 1 and 2 days after surgery were increased, intraoperative consumption of propofol was decreased, QoR-15 score at each time point after surgery was increased ( P<0.05), and no significant change was found in the incidence of sleep disorders at each time point in group B2 ( P>0.05). There was no significant difference in CPR concentrations and the number of rescue analgesia after surgery at each time point among the 3 groups ( P>0.05). Conclusion:General anesthesia guided by BIS can improve postoperative sleep quality in elderly patients undergoing laparoscopic gastrointestinal tumor surgery, and BIS value maintained at 50-60 provides better effect on postoperative sleep quality and is more helpful for postoperative recovery.