| Objective:The purpose of this study was to find ways to reduce intraoperative glandular secretion in patients by observing the effects of different depths of anesthesia on glandular secretion under Narcotrend monitoring,to reduce the use of unnecessary anticholinergic drugs,and to improve thequality of anesthesia and patient comfort.Methods:Ninety patients,aged 40 to 75 years,who underwent elective laparoscopic total hysterectomy from April 2021 to October 2021 in our hospital were selected.Signed informed consent form with patient before surgery,and all patients were randomly divided into three groups by random number method: Conventional anesthesia group(group D,depth of anesthesia D0-D2);deep anesthesia group(group E,depth of anesthesia E0-E1);positive control group(group C,Penehyclidine hydrochloride given before anesthesia,no depth of anesthesia monitoring used),and 30 cases in each group.Basal salivary secretion is measured with specific test strips after the patient is admitted to the operating room.In Group D and group E,researchers will clean the patient’s head skin with alcohol gauze,three specialized electrode patches are placed on the forehead and Narcotrend single-channel monitoring is then initiated.Group C was given penehyclidine hydrochloride 0.01 mg/kg intravenously 10 min before the start of anesthesia.Anesthesia induction program: After adequate pre-oxygenation,midazolam 0.05mg/kg,fentanyl 4μg/kg and propofol 1.5-4.0mg/kg were injected sequentially,and rocuronium 0.8mg/kg was injected slowly after the patient fell asleep.after the muscle relaxants were fully effective and the appropriate depth of anesthesia was reached,tracheal intubation was performed,and the position of the catheter was determined and fixed.Pump injection of propofol and remifentanil to maintain anesthesia during surgery.Groups D and E maintained Narcotrend Index(NI)between 64-37 and 36-20 byadjusting the pumping rate of propofol and remifentanil,and Group C had the anesthesiologist adjust the depth of anesthesia according to the patient’s vital signs.In all three groups,thirty minutes after the start of the procedure,salivary secretion of the patient under anesthesia was measured using test strips.At the end of the procedure,when the patient woke up and reached the indication for extubation,the airway and oral secretions were drawn out using a disposable sputum culture bottle and the dry mouth visualanalogue scale(VAS)score was measured 10 minutes after extubation.Basal saliva secretion and saliva secretion under anesthesia were recorded for each group;Recording the amount of secretions collected in each group of sputum culture bottles;Basic information of the three groups of patients was recorded: age,body mass index(BMI),height,and American Society of Anesthesiologists(ASA)classification;Recording Meanarterial pressure(MAP)and heart rate(HR)at six time points: before induction of anesthesia(T0),at the time of tracheal intubation(T1),immediately after the establishment of pneumoperitoneum(T2),60 min after tracheal intubation(T3),at the end of surgery(T4)and 10 min after extubation(T5);Recording the duration of surgery,bleeding volume,infusion volume,urine volume;Recording the use of propofol,remifentanil and vasoactive drug;Recording eye opening time,extubation time,hospitalization time,postoperative nausea and vomiting(PONV),intraoperative awareness,postoperative agitation and other complications;Recording the dry mouth VAS score ten minutes afterextubation.Results:1.There was no statistically significant difference in age,height,weight,BMI,and ASA classification among the three groups(P > 0.05).2.There was no statistically significant difference in intraoperative blood loss,infusion volume,urine volume,operation time,eye opening time,extubation time and hospital stay among thethree groups(P >0.05).3.At T1,MAP was significantly higher in group D,group E and group C than T0(P <0.05),and there was no statistically significant difference between T2,T3,T4 and T5 compared with the T0 time point(P > 0.05);comparison between groups: at T1 time point,MAP was significantly higher in group D and group C compared with group E(P < 0.05),and the difference between groups compared with T0,T2,T3,T4 and T5 was not statistically significant(P > 0.05).The differences in HR at different time points were statistically significant(P < 0.05).Compared with T0,HR was higher in all three groups at T1(P < 0.001),and at T2,T3,and T4,HR was lower in all three groups than T0(P < 0.01),and the difference between T5 and T0 was not statistically significant(P > 0.05),and the difference in HR at each timepoint inthe three groups was nostatistically significant difference(P>0.05).4.More propofol and remifentanil use in group E compared to group D and group C,the difference was statistically significant(P < 0.05).There was no statistically significant difference in the use of vasoactive drugs among the three groups(P > 0.05),and there was no statistically difference in the incidence of adverse reactions such as nausea and vomiting,intraoperative knowledge,and postoperative agitation among the three groups(P > 0.05).5.Salivary secretion under general anesthesia was reduced in all three groups compared to the basal values,and the difference was statistically significant(P < 0.05).The smallest reduction was observed in the D group(P < 0.05)and the largest reduction in the C group(P <0.001),The amount of respiratory gland secretion during the whole operation was from more to less in the order of group D,group E and group C.The difference between the three groups was statistically significant(P < 0.001).6.There was a statistically significant difference in the VAS scores of dry mouths among the three groups(P < 0.001).No statistically significant difference compared to group L and group M(P > 0.05).Conclusion:1.general anesthesia suppresses the patient’s glandular secretion and the suppression becomes more pronounced as the anesthesia deepens.2.Maintaining the depth of anesthesia E0-E1 can effectively reduce the patient’s glandular secretion,more stable intraoperative vital signs,and more comfortable patient awakening period without increasing theincidence ofadverse reactions. |
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