Influence of the anesthetic depth on the inhibition of the oculocardiac reflex compare sevoflurane with target controlled infusion propofol anesthesia for paediatric strabismus surgery / 中国医师进修杂志

ABSTRACT

Objective To observe the effect of sevoflurane and target controlled infusion (TCI)propofol on the oculocardiac reflex (OCR) in patients with paediatrie strabismus surgery.Methods One hundred and thirty-eight patients ASA Ⅰ-Ⅱ undergoing strabismus surgery were randomly allocated to six greups(propofol groupsP_1,P_2,P_3 group; sevoflurane groupsS_1,S_2,S_3 group,23 cases for each) according to target bispectral index (BIS) of 60,50 and 40.In propofol groups continuous infusion of propofolremifentanil [0.2μg/(kg·min)] was adjusted towards target BIS value.The sevoflurane-remffentanil [0.2μg/(kg·min) ] concentration with 50% N2O/O2 was adjusted toward target BIS too.The incidence of OCR and the lowest heart rate(HR) and BIS were recorded.Results The incidence of OCR were 73.9%(17/23),39.1%(9/23),17.4%(4/23),56.5%(13/23),26.1%(6/23),8.7%(2/23)in P_1,P_2,P_3,S_1,S_2,S_3 soup,P_2 and P_3 group were lower than P_1 group,S_2 and S_3 soup were lower than S_1 group,P_3,S_3,S_2,P_2 group were lower than S_1 and P_1 soup,S_1 soup was lower than P_1 group,S_2 soup was lower than P_2 group,S_3 group was lower than P_3 group,there was significant difference(P < 0.05 ).The densities of TCI propofol in P_2 and P_3 soup were higher than that in P_1 group [ (4.3 ±0.2),(5.5±0.1 ) mg/L vs (3.2±0.1 ) mg/L ] (P <0.05),and the densities of sevoflurane in S_2 and S_3 group were higher than that in S_1 group [ ( 1.8±0.3 )%,(2.3±0.2 )% vs(1.3±0.2 )% ] (P<0.05 ).The end-tidal concentration was different with difference of BIS too.Conclusions OCR is relevant to the depth of anesthesia.BIS values of 40-50 seem adequate for the inhibition of OCR.The results suggest that BIS may be a valuable tool during propofol-remifentanil or sevoflurane-remifentanil anesthesia for strabismus surgery in children.The incidence of OCR is higher in propofol than in sevoflurane at the same BIS.