The Applications Of Target-controlled Infusion Of Propofol Combined With Sufentanil In Glioma Surgery

Objective:To study the right infusion doses of sufentanil in glioma surgery by using total intravenous anesthesia with target-controlled infusion (TCI) of propofol combined with sufentanil, and observing the change of hemodynamic and the level plasma cortisol.Methods:Sixty patients, ASA I-II, scheduled to undergo craniotomy for glioma resection, randomly divided into three groups:S1, S2 and S3(n=20). Inductions of anesthesia were similar in three groups. Anesthesia was maintained with on-demand intravenous vecuronium, TCI of propofol and constant infusion for three doses sufentanil 0.15μg/kg/h, 0.30μg/kg/h and 0.45μg/kg/h respectively. Recorded the mean arterial pressure (MAP) and the heart rate (HR) at different points during surgery. The points were basic value (TO), skin incision (T1), remove skull (T2), cut dura (T3), cut tumor (T4) and skin seam (T5). The vein blood were collected at T0,T3,T5 and measured the plasma cortisol (COR) by radioimmunoassay. Recorded the change of hemodynamic and analyzed of the reasons, a dose of sufentanil 0.25 mg/kg or nitroglycerin 0.25～0.5 mg or dopamine 1～2 mg was given when MAP was increase or decrease 20% the basic, and atropine 0.25～0.5 mg was given when HR was lower 60 per minute. Compared the MAP, HR, COR and the frequency of sufentanil, nitroglycerin, dopamine, atropine and the amount of propofol.Results:1. The three groups were similar with respect to general conditions, operative duration, fluid volume and the amount of bleeding (P>0.05).2. The frequency of atropine:S1 was significantly lower than that of S2 and S3 (P<0.05). S2 was significantly lower than that of S3 (P<0.05).3. The frequency of nitroglycerin, dopamine and the amount of propofol:There was no statistically significant in all groups (P>0.05).4. The frequency of sufentanil:S2 and S3 were significantly less than that of S1 (P<0.05), but no statistically significant between S2 and S3 (P>0.05).5. The total dose of sufentanil:S1 and S2 were significantly less than that of S3 (P<0.05), but no statistically significant between S1 and S2 (P>0.05).6. MAP:S2 was significantly lower than that of S1 at T4 and T5 (P<0.05); S3 was significantly lower than that of S1 at T3, T4 and T5 (P<0.05); MAP was significantly lower at TO compared with T5 in group S1 and it was reverse in group S2 (P<0.05); MAP were significantly lower at T3, T4 and T5 compared with TO in group S3 (P<0.05). 7. HR:S2 and S3 were lower than that of S1 at T2, T3, T4 and T5 (P<0.05); S3 were lower than that of S2 at T2, T3, T4 and T5 (P<0.05); HR was lower at TO compared with T4 and T5 in group S1 (P<0.05); HR was higher at TO compared with T2, T3, T4 and T5 in group S3 (P<0.05).8. COR:S2 and S3 were lower than that of S1 at T3 and T5 (P<0.05); COR were higher at TO compared with T3 and T5 in all groups (P<0.05).Conclusions:1. The sufentanil dose 0.3μg/kg/h and 0.45μg/kg/h was slighter and two doses of the inhibitory effect of the stress response is stronger than 0.15μg/kg/h.2. The sufentanil dose 0.15mg/kg/h could not meet the requirements of surgery, while 0.45μg/kg/h greater impact on HR, 0.3μg/kg/h could meet the requirements of surgery, however, we should adjust slightly the dose of sufentanil around 0.3μg/kg/h based on the degree of surgical stimulation.