Application Of Surgical Pleth Index Monitoring In Elderly Patients Undergoing Laparoscopic Surgery

Objective:This study compared the effects of surgical pleth index guided drugs on intraoperative anesthetic dose,hemodynamic fluctuations,and postoperative recovery to assessing the feasibility of SPI to guide the applying of analgesics and maintaining hemodynamic stability in the elderly patients during laparoscopic surgery and provide a basis for its clinical application in the future.Methods:Forty adults aged greater than 60 years old years old,American Society of Anaesthesiologists status I to III who were scheduled for elective laparoscopic gynecologic surgery under general anesthesia,They were randomly divided into study group and control group with 20 cases in each group.The dosage of propofol were controlled according to state entropy(SE)in the both groups.the administration of remifentanil were supervised by an additional monitor of SPI in the group experimental(group E),while adjusted by the anesthesiologist adjusted according to the vital signs of the patient in the group control(group C).Mean arterial pressure(MAP),heart rate(HR)and SPI were recorded before anesthesia induction(T0),before incision(T1),immediate incision(T2),insertion of pneumoperitoneum(T3),5,10,30 min after pneumoperitoneum insertion(T4,T5,T6),immediate pneumoperitoneum(T7),end of surgery(T8),immediate extubation(T9).The total dose of propofol and remifentanil,the recovery time,extubation time,and visual analogical scores(VAS)were recorded.The number of opioid adverse events,the number of hemodynamic adverse events and applications for vasoactive drugs were observed and recorded.Results:Compared with T1,the MAP and SPI at the time of T2,T3 and T4 were significantly increased in both groups(P<0.05);Compared with the group C,the increase of MAP and SPI at the T3,T4,and T5 levels in the group E were small(P<0.05);The dose of propofol in the two groups,postoperative recovery time,extubation Time,VAS,opioid-related adverse reactions(awakening delay and vomiting,respiratory depression)were not significantly different(P>0.05),remifentanil dose group E was significantly lower than group C(P<0.05);There was a difference in the incidence of hemodynamic adverse events between the two groups,The incidence of bradycardia and atropine in group E was significantly lower(P<0.05);The incidence of hypotension,Intraoperative hypertension and tachycardia and the use of ninidine,esmolol and ephedrine use rates were not statistically significant.(P>0.05).Conclusion : The use of surgical pleth index(SPI)to guide anesthetic infusion in laparoscopic surgery in elderly patients is beneficial to reduce the dose of remifentanil,stabilize hemodynamics and reduce the incidence of postoperative adverse events.