Clinical Study Of Perioperative Monitoring Cerebral Function

Part one: The brain distribution and memory alteration of propofol under epidural anesthesia combined propofol sedation by EEG non-linear analysisObjective: To study the brain distribution and memory effect of propofolunder epidural anesthesia combined propofol sedation with EEG non-linearmonitor.Methods: 20 patients, ASAI-II, age: 49.45±7.55years old, height: 174.5 ±3.5cm,weight: 66.85 ± 7.57kg,were chosed to underwent expected abdomen and limb operations. They were randomly divided into 2 groups: group I (propofol :5mg·kg-1· h-1) and group II (propofol :6mg·kg-1·h-1).Patients were notpremedicated. The narcosis was maintained by epidural anesthesia and propofol sedation. The EEG non-linear parameters: Correlation Dimension (D2), Approximate Entropy (ApEn), Complexity (Cx) and Topographic Map of Approximate Entropy were recorded. The perioperative-recorded periods were entering room, before sedation, after sedation, skin incision, operation stage, intraoperation, and resuscitation, awake. After sedation's EEG was recorded after the propofol was balanced 25 minutes, and the EEG of intraoperation were recorded all length average of operation periods. Different audio vocabularies were given to all patients before sedation and intraoperation. The patients'explicit memory and implicit memory were estimated by Process dissociation Procedure (PDP) after patients were awake. The hemodynamics parameters were monitored regularly.Results: There were not statistically different at age, height, weight, sex, and education levels between the two experimental groups. Comparing to the data of entering room of the two experimental groups, the data of MAP were descending, HR were ascending, EEG non-linear parameters: Correlation Dimension (D2), Approximate Entropy (ApEn), Complexity (Cx) were descending after sedation of the two experimental groups. There were significantly statistical difference (P<0.05)between entering room and after sedation of the two experimental groups: The Process dissociation Procedure(PDP) test showed : Group I(propofol iSmg·kg-1·h-1) patients: comparing to pre-operation explicit memory's results, the results of intra-operation explicit memory were distinctly descending. There were statistically different between the pre-operation explicit memory's result and intra-operation explicit memory's result (P<0.05). There were, not statistically different between the pre-operation implicit memory's result and intra-operation implicit memory's result (P>0.05). Group II (propofol :6mg·kg-1·h"')patients: comparing to pre-operation explicit memory's results, the results of intra-operation explicit memory were distinctly descending. There were statistically different between the pre-operation explicit memory's result and intra-operation explicit memory's result (P<0.05). Comparing to pre-operation implicit memory's results, the results of intra-operation implicit memory were distinctly descending. There were statistically different between the pre-operation implicit memory's result and intra-operation implicit memory's result (P<0.05). There were statistically different of PDF test between the intra-operation explicit and implicit memory's results of two experimental groups (p<0.05) .Without implicit memory, the EEG non-linear parameterscritical values were: Correlation Dimension (D2):3.30 (sensitivity: 71.7%,specificity: 86.2%), Approximate Entropy (ApEn): 0.55 (sensitivity: 81.4% ,specificity: 92.4%), Complexity (Cx):0.29(sensitivity:69.4%,specificity: 83.2%). The Approximate Entropy (ApEn) had best sensitivity and specificity among all EEG non-linear parameters. With Approximate Entropy (ApEn) topographic map' observation, the propofol brain distribution'sequence were: parietal and occipital area→frontal and temporal area( from left temporal area to frontal areaand right temporal area) →all brain cortex. The propofol brain resuscitationclearance'sequence were: frontal and temporal area( from left temporal area to frontal area and right temporal area) →:pa...