WHAT THIS STUDY ADDS -
- It’s not true that the higher concentration of the REM, the lower
concentration of propofol is more beneficial to the patient. The
optimal effect-site concentration of remifentanil and propofol can be
recieved.
- DSA can assist in the evaluation of the situation of analgesic drug
compared with PSI reflects anesthesia depth.
- PSI performs better than BIS in detecting consciousness.
Abstract
Backgroud : To determine the
most suitable effect-site concentration of remifentanil and propofol for
keeping proper anesthesia depth and early recover quickly under guidance
of patient state index (PSI). Methods ː Elective gynecological
laparoscopic surgery patients received concentration of propofol in high
concentration (3 ug/mL, N = 25), middle concentration (2.5 ug/mL, N =
24), low concentration (2 ug/mL, N = 28) during maintenance. After
finished intubation, propofol was adjusted to the target concentration
by grouping, the concentration of remifentanil relied on the reaction of
the formerly tested patient using 0.4 ng/mL as a step size began with
3.5ng/mL under PSI monitored. The primary measurements were the
concentration of remifentanil, the change of intra-procedural data, and
post-operation data including times to handle the change of the depth of
anesthesia, blood pressure (BP) and heart rate (HR), extubation time,
duration in PACU, hospital day, VAS score in the first day after sugery.
Secondary measurements were density spectral array, intra-operative
awareness, postoperative delirium. Results: The group of middle
concentration required the minimum time for extubation and staying in
PACU, kept steady process of anesthesia (P<0.05), the EC50 of
remifentanil to suppression irritation from incision were 2.96 ng/mL
(95% CI 2.75 to 3.14 ng/mL) in this group. Besides, low doses of
remifentanil were more obvious than high doses in alpha wave of Density
spectral array. Conclusions: With PSI guided anesthesia, the
effect-site concentration of propofol was 2.5 ug/mL, keep stable
anesthesia process and effective early postoperative recovery,
meanwhile, EC50 of remifentanil was 2.96 ng/mL.
Key words: Remifentanil; Propofol; Electroencephalography;
Conscious Sedation; Anesthetics, Intravenous