ABSTRACT
OBJECTIVE: To evaluate the effect of bi-level positive airway pressure ventilation (BiPAP) for post-extubation respiratory support under deep anesthesia in hypertension patients. METHODS: Forty primary hypertension patients who were scheduled for lower abdominal surgery or total hip joint replacement were randomly divided into 2 groups: one was extubated when being awake (Group A, n = 20, and the other was extubated under deep anesthesia (Group B, n = 20). The combined inhalation and the intravenous general anesthesia were performed on all patients, and inhalation anesthesia was maintained with only continued infusion of propofol when major procedure of surgery had been finished. In Group A, anesthesia was ceased when the surgery was finished, and trachea was removed after the patients awoke. In Group B, anesthesia was ceased immediately before the extubation, and trachea was removed under deep anesthesia, followed by an uninvasive ventilation of BiPAP. Blood pressure (BP, heart rate ( HR, and bispectral index (BIS) before or after the extubation, artery blood-gass analysis in BIPAP, and the incidence rate of complication in the recovery period were recorded. RESULTS: In Group A, BP and HR increased significantly after the patients awoke (P < 0.01) and after the extubation (P < 0.05), compared with the data before the surgery and before the extubation. In Group B, however, BP and HR had no difference before and after the extubation, and the data of blood gas maintained approximately normal. The incidence rate of glos- soptosis in Group B was obviously higher than those in Group A (P < 0.01), while complications such as cough during the recovery stage in Group A were more than those in Group B (P <0.05). CONCLUSION: BiPAP is suitable for post-extubation respiratory support under deep anesthesia in hypertension patients.
Subject(s)
Abdomen/surgery , Anesthesia, General , Continuous Positive Airway Pressure/methods , Device Removal , Hypertension/complications , Aged , Arthroplasty, Replacement, Hip , Female , Humans , Intubation, Intratracheal , Male , Middle AgedABSTRACT
OBJECTIVE: To observe the effects of desflurane on A-line ARX Index (AAI), QEEG, MAP and HR, and to investigate the feasibility of AAI, QEEG, MAP and HR in monitoring the depth of anesthesia with desflurane. METHODS: Thirty patients classified as ASA physical status I approximately II were scheduled for elective lower abdominal surgery. Anesthesia was induced with propofol and vecuronum. After the tracheal intubation, the lungs were ventilated with desflurane in oxygen. End-tidal desflurane concentrations were maintained at 0.8, 1.0 and 1.3 MAC for 20 minutes, respectively. The parameters of record included AAI, BIS (bispectral index), SEF (95% spectral edge freqency), MF (midian freqency), MAP and HR. RESULTS: AAI, BIS, SEF and MF significantly decreased in a linear manner (r = 0.830, 0.930, 0.803, and 0.885, respectively, P < 0.01) with increasing end-tidal concentration of desflurane range of 0.8 approximately 1.3 MAC. MAP and HR did not change much. HR increased significantly at concentration 1.3 MAC than that of 1.0 MAC. CONCLUSION: Within end-tidal desflurane concentration range 0.8 approximately 1.3 MAC, both AAI and parameters derived from EEG (such as BIS, SEF, MF) can serve as parameters in monitoring the depth of anesthsia with desflurane, while MAP and HR can not.
