Compare The Effect Of Prevention Of Emergence Agitation Of Two Different Dosing Regimens Of Fentanyl For Lung Cancer Operation

Purpose：Observe the effect of the intraoperative hemodynamic andemergence anesthesia with two dosing regimens of equal fentanyl in thepatients with thoracotomy for lung cancer operation.Method：Choice68patients during August2012to December2013in our hospital with lung cancer surgery whose ASA II-III,50-70yearsold,60-80kg were randomly divided into group A(preemptive analgesiagroup) and group B(intraoperative additional group).Routine monitor blood pressure (BP),electrocardiogram (ECG), heartrate (HR),oxygen saturation (SpO2), central venous pressure(CVP),bispectral index (BIS) when the patient enters the operating room.The two groups to be induced with midazolam0.08mg/kg, cisacidatracurium0.15mg/kg, etomidate fat emulsion0.3mg/kg, fentanyl citrate,which anesthetics is the same doses except fentanyl. Insert theendotracheal tube after3-5min from inject cisacid atracurium,and thencontrol breathing with the ventilator. Intermittent intravenous bolusatracurium0.04-0.08mg/kg and infuse propofol4-12mg/(kg.h),remifentanil0.25ìg/(kg.min) to maintain anesthesia.group A：Injectfentanyl4μg/kg when induced and then give fentanyl3μg/kg at5minute before the surgery beginning. group B：Inject fentanyl3μg/kg when induced and give fentanyl2μg/kg at5minute before the surgerybeginning. Then give1μg/kg per hour. The final Fentanyl amount isequal. The systolic blood pressure (SBP), mean arterial pressure (MAP),pulse rate (HR) were monitored and recorded in the two groups ofpatients before induction (T0), after induction (T1), after intubation (T2),after the operation starts (T3),1hours after the start of surgery (T4), theend of surgery (T5), extubation (T6),15minutes after the extubation(T7).Observe the patient’s recovery index after extubation reaction, RecordVAS pain score and Riker agitation-sedation score.Results:(1)In the two groups of the patients, systolic blood pressure,mean arterial pressure, pulse rate, bispectral index was no significantdifference (P>0.05) before induction (T0).(2)Compared with groupA,hemodynamic of group B fluctuate significantly at the points T2andT3with significant difference (P <0.05).(3) In the two groups of thepatients, the time of breathing recovery, eyes open, complete instructionsexactly and extubation were significant difference (P <0.05).(4) In the twogroups of the patients, emergence agitation and drowsiness afterextubation were significant difference (P <0.05).(5) In the two groups,the patients of indolent at the time of5,10,15minute after extubationwere significant difference (P <0.05). the patients with standly slight painat the time of5,10minute after extubation were significant difference (P<0.05). the patients with pain which affect sleep at15minute after extubation were significant difference (P <0.05).(6) In the two groups, thepatients of peaceful cooperation and very agitation after extubation weresignificant difference (P <0.05).Conclusion： Compare with intraoperative additional group,preemptive analgesia group with more stable hemodynamics, effectivelyanalgesia and less restless patients, more rapidly and steady analepsia,less complications, can be used as more valuable method in patientswith lung cancer surgery anesthesia.