Effect Of Different Levels Of Bispectral Index On Postoperative Sleep Quality And Postoperative Fatigue In Elderly Patients Undergoing Laparoscopic Gastrointestinal Tumor Surgery

Objective To assess the contribution of different levels of bispectral index on postoperative sleep quality and fatigue in elderly patients undergoing laparoscopic gastrointestinal tumor surgery.Methods Recruit 90 patients undergoing elective laparoscopic gastrointestinal tumor surgery who meet the requirements of the trial,sex unlimited,aged 60-80yr,with body mass index(BMI)of 18-25.0 kg/m~2,ASA gradeⅠ-Ⅲ.B1 group(maintain the BIS value at between 40-49),B2 group(maintain the BIS value at between50-60),C group(maintaining intraoperative heart rate or blood pressure at±20%of base value).ECG,noninvasive blood pressure(NIBP),heart rate(HR),pulse oxygen saturation(SPO2)were monitored after entering the room.Anesthesia was induced with intravenous Midazolam 0.04 mg/kg,propofol 2-2.5mg∕kg,sufentanil 0.2-0.4μg∕kg and cisatracurium 0.15 mg∕kg.Anesthesia was maintained with propofol 3-6mg∕kg,remifentanil 0.1-0.2μg∕kg/min,cisatracuriu m 0.04-0.06 mg∕kg and sevoflurane(0.3MAC).The B1 group and B2 group underwent adjustment of anesthesia to keep the BIS value at between 40-49 and 50-60;the C group maintain intraoperative heart rate or blood pressure at±20%of base value.The Pittsburgh Sleep Quality Index(PSQI)scores were recorded at 1 day before operation and 1,3,7 and 30days after operation,and Christensen’s Fatigue Scale(CFS)was used for assessing postoperative fatigue at the same times;The Portable Sleep Monitor(PSM)was performed on 1 day before operation and 1,2 and 3 days after operation.The Quality of Recovery-15(Qo R-15)scores were measured at 1,3 and 7 days after operation;Spitzer’s Generalized Anxiety Disorder(GAD-7)scale was used on 1 day before operation,and 7 days after operation.The total dose of general anesthetics,VAS score at 8h,12h,24h,48h after operation,recovery time of bowel movement,the first time out of bed,postoperative complications,Plasma concentration of C‐reactive protein(CRP)1 day before operation and 1 day after operation,and duration of hospital stay were recorded.Results (1)The study initially included 90 patients undergoing laparoscopic gastrointestinal surgery,2 patients were converted to laparotomy,3 patients failed postoperative follow-up,and 2 patients lost more than 1000ml during the operation.In the end,83 patients completed the study,28 in group B1,28 in group B2,and 27 in group C.There was no significant difference in age,sex,BMI,basic illness,nutritional risk screening 2002 score,preoperative albumin concentration,preoperative hemoglobin concentration,duration of anesthesia(h),duration of surgery(min),actual blood loss(m L).(2)The total consumption of remifentanil and sufentanil has no differences among the three groups(P>0.05,respectively);compared with group C,the total consumption of propofol during operation in groups B1 and B2 was significantly lower,and B2 group was lower than group B1(884.64±153.18 vs751.79±95.61 vs 1109.26±125.82)(P<0.05,respectively).(3)Compared to C group,PSQI scores in groups B1 and B2 were lower at 1,3 days followed up the operation;and B1 group was higher than group B2(P<0.05);there was no significant difference in PSQI scores at 7 days and 30 days followed up the operation(P>0.05).(4)Compared to C group,sleep duration,the total score of sleep,the proportion of rapid eye movement sleep were increased in B1 and B2 groups at 1,2days after surgery(P<0.05,respectively).There were additional sleep duration and the proportion of rapid eye movement sleep in B2 group than those of B1(P<0.05).(5)Compared to C group,Christensen’s Fatigue Scale in groups B1 and B2 were lower at1,3,7 days after surgery(P<0.05).(6)Compared to C group,Qo R-15 scores at 1,3,7 days after operation were increased in B2 group and B1 group(P<0.05),and B2 group was higher than group B1(P<0.05).(7)Compared to C group,lower GAD-7scores in groups B1 and B2 at 7 days after surgery(P<0.05).(8)There was longer hospital stays in C group compared to other groups(P<0.05).No statistically significant difference in VAS score,opioids consumption,recovery time of bowel movement,the first time out of bed,postoperative complications,C-reactive protein concentration among three groups(P>0.05).Conclusion Intraoperative BIS maintained at 50-60 has less effect on postoperative sleep in elderly patients undergoing gastrointestinal surgery.It can increase the proportion of rapid eye movement sleep and sleep duration to a certain extent,increase the early postoperative PSQI score,and improve the quality of recovery within one week after surgery.General anesthesia under the guidance of BIS can reduce postoperative fatigue and shorten the total length of hospital stay.