The Correlation Between Anesthesia Index And Hemodynamics And Its Clinical Application In Total Total Intravenous Anesthesia

Objective:The purpose of this study was to explore the correlation between Anesthesia index and hemodynamic changes in patients undergoing total intravenous anesthesia（TIVA）and to discuss the clinical effect and value of Ai.Methods:Test 1:Selected patients with TIVA from June,2018 to June,2019,aged 18⁶5 years old,grade ASAI^II.120 patients were enrolled,target controlled infusion of propofol and remifentanil,intravenous injection of midazolam and cisatracurium during induction.During the operation,propofol and remifentanil were continuously administered by target controlled infusion,and muscle relaxants were added intermittently.The depth of anesthesia was determined by Ai and the input of propofol and remifentanil was adjusted to maintain Ai at 40⁶0.HR,MAP and Ai were recorded before anesthesia induction（T0）,1 min before endotracheal intubation（T1）,during endotracheal intubation（T2）,during skin cutting（T3）,at the end of surgery（T4）and before extubation（T5）.Pearson coefficient was used for correlation analysis.Test 2:52 patients were enrolled from April,2019 to June,2019,the inclusion and exclusion criteria,the methods of anesthesia induction and anesthesia maintenance were the same as experiment1.They were randomly divided into the hemodynamics monitoring group（H group,n=26）and the Anesthesia index monitoring group（A group,n=26）.The fluctuation range of MAP and HR was maintained at±20%in group H,while that in the A group was maintained at the Ai value of 40⁶0.The values of MAP、HRand Ai before induction（T0）,immediately after endotracheal intubation（T1）,at skin resection（T2）,at the end of operation（T3）,at extubation（T4）were observed and recorded,and blood glucose and cortisol concentrations were measured in peripheral blood.The extubation time,wake time,Postanesthesia care unit（PACU）stay time,total input of propofol and remifentanil,times of use of vasoactive drugs and intraoperative adverse reactions were recorded.Results:Test 1:Compared with T₁,MAP and Ai increased at T₀,T₂,T₃,T₄ and T₅,while HR increased at T₀ and T₂（P<0.05）;Compared with T₃,MAP and Ai increased at T₀,T₄ and T₅,while HR increased at T₀ and T₂（P<0.05）.The correlation coefficient between Ai and HR was 0.333,positive correlation and medium correlation;The correlation coefficient between Ai and MAP is 0.710,which is positively correlated and strongly correlated（P<0.05）.Test2:Compared with group H,MAP in group A decreased at T1,T2,T3 and T4,blood glucose decreased at T2,T3,cortisol decreased at T2,T3and T4,the extubation time and wake time were shortened,the dosage of propofol and the use frequency of vasoactive drugs were reduced,the difference was statistically significant（P<0.05）.Conclusions:Anesthesia index is positively correlated with hemodynamic changes,and the change of mean arterial pressure better reflects the depth of anesthesia.The Anesthesia index can be applied to direct anesthesia depth by total intravenous anesthesia,stabilize hemodynamics,inhibit stress response,shorten extubation time,wake time,and reduce the amount of anesthetic drugs,which has high clinical application value.