Clinical Effects Of Different Propotions Of Etomidate And Propofol In General Anesthesia

Objective The aim of this project was to investigate the clinical utility of combinated infusion of etomidate and propofol with different propotions under target controlled infusion(TCI)in patients with general anesthesia.Explore the optimal compatible dose with intraoperative hemodynamic stability and postoperative sleep and recovery in good conditions,thus provide new ideas and reference for clinical anesthesia.Method One hundred and twenty-eight patients who were aged 18-60 years old,ASA physical states I-II and undergoing laparoscopic gynecological surgeries with general anesthesia were randomised to one of the four groups,Group P,Group EP1:2,Group EP1:1,Group EP2:1.The administration parameters of plasma concentration were set.For induction,patients in each group received midazolam 0.05mg/kg and sufentanil 0.3μg/kg.Group P received propofol 3μg/mL TCI.Group EP1:2 received etomidate 0.2μg/mL TCI and propofol 2μg/mL TCI.Group EP1:1 received etomidate 0.3μg/mL TCI and propofol 1.5μg/mL TCI.Group EP2:1 received etomidate 0.4μg/mL TCI and propofol 1μg/mL TCI.Then rocuronium 0.6mg/kg was injected.After the muscle relaxant was fully effective,the laryngeal mask was placed and mechanically ventilated.For maintenance,the four groups kept the same infusion doses as before.Remifentanil was infused as 0.05-0.2μg/kg/min continuely.Sufentanil 0.3μg/kg was added just before skin incision and rocuronium was injected intermittently during surgery.When suturing the skin,TCI was stopped but remifentanil was kept until the end of surgery.Flurbiprofen axital 5mg and tropisetron 5mg were provided.After the recovery of spontaneous breathing,neostigmine 2mg,atropine 0.5mg and flumazenil 0.3mg were injected.Main observed indicators:(1)MAP,HR and BIS at different time points: baseline(T0),after induction 1min(T1),after intubation 1min(T2),at the time of skin incision(T3),10 min after skin incision(T4),30 min after skin incision(T5),1h after skin incision(T6)and the end of surgery(T7).(2)Duration of eyelid reflex loss,awakening and extubation,dose of remifentanil.(3)Adverse reactions.(4)Evaluate the sleep duration,fatigue severity scale(FSS)score and 40-item quality of recovery questionnaire(QoR-40)score before surgery(T0),the first(D1),second(D2),third(D3)and seventh(D7)day after sμgery,as well as the pittsburgh sleep quality index score at D0 and D7.Results 1.Haemodynamics: The fluctuation of MAP and HR in Group EP2:1 was less at T1 and T2(P<0.05),while from T3 to T7 those increased significantly higher(P<0.05).The change was the minimum in Group EP1:2(P<0.05).BIS in Group EP1:2 and Group EP2:1 were lower than Group P from T2 to T7(P<0.05).2.Duration of eyelid reflex loss,awakening and extubation,dose of remifentanil: the values in Group EP2:1 were higher than Group P(P<0.05).There was no statistical significance between Group EP1:2 and Group P(P>0.05).3.Adverse reactions: No statistical significance between Group EP1:2 and Group P was observed(P>0.05).The incidence of myoclonus,agitation and vomiting in Group EP1:1 and Group EP2:1 increased compared to Group P(P<0.05).4.Postoperative sleep duration: Duration of postoperative sleep on D1 and D2 in Group EP1:2,Group EP1:1 and Group EP2:1 was much longer than Group P(P<0.05)and it was the longest in Group EP2:1.But it reduced on D7 in Group EP1:1 and Group EP2:1 compared with D0(P<0.05).The changes in Group EP1:2 had no statistical significance with Group P(P>0.05).5.FSS scores: From D1 to D3,the scores in Group EP2:1 were much higher than Group P(P<0.05),and they rised significantly in Group EP1:1 and Group EP2:1 than D0(P<0.05).The changes in Group EP1:2 were similar to Group P(P>0.05).6.Qo R-40 scores: There was no statistical significance between Group EP1:2 and Group P.Scores were lower in Group EP2:1 than Group P on D2 and D3(P<0.05).7.PSQI scores: The score in Group EP2:1 on D7 was higher than D0,as well as Group P at the same time point(P<0.05).Conclusion According to the clinical effects of different propotions of etomidate and propofol in gerenal anesthesia,the finding of this study is the combinated infusion of etomidate and propofol with 1:2 ratio that is etomidate 0.2μg/ml TCI and propofol 2μg/ml TCI is preferable for laparoscopic gynecological surgery.It can effectively maintain the haemodynamic stability,appropriately extend the early postoperative sleep duration,reduce fatigue and enhance recovery after surgery.