Analysis Of The Effects Of Different Dosages Of Afentanil For Anesthesia Induction In Endoscopic Treatment Of Esophageal Varices In Patiens With Liver Cirrhosis

ObjectiveTo explore and compare the appropriate dosage of afentanil in anesthesia induction for esophagogastric varices(GOV)gastroscopy in cirrhosis,so as to provide reference for the selection of tracheal intubation anesthesia in clinical patients with cirrhosis.MethodsSixty patients aged 40-65 years old,male and female,with body mass index of18.5 ~ 23kg/m2,were selected from Shenyang Sixth People’s Hospital from November2021 to June 2022 to receive endoscopic treatment for esophageal and gastric varices.Sixty cases of patients with esophageal and gastric varices of liver cirrhosis with ASA gradeⅢ and Child grade A received gastroscopy.The subjects were divided into two groups according to random number table method,with 30 cases in each group:Afentanil 10ug/kg group A1(n=30)and afentanil 20ug/kg group A2(n=30).There was no history of opiates or toxic and anesthetic drug abuse before surgery.At least two intravenous channels were established for all patients to prepare blood,and proton pump inhibitors were injected intravenously once 30 min before surgery.Somatostatin was continuously injected intravenously through one intravenous channel during the operation.In addition,sodium lactate Ringer’s solution was injected intravenously in one route,and non-invasive blood pressure(NIBP)was detected by connecting a monitor after invasion.pulse oxygen saturation(Sp O2),electrocardiogram(ECG),heart rate(HR),Bispectral Index(BIS)and basic vital signs were collected.All patients received intravenous rapid induction anesthesia,the specific program is as follows.At the anesthesia induction stage,pure oxygen was inhaled by mask for 3min.Group A1 was given midazolam(0.02-0.04mg/kg),propofol(1-2mg/kg),cisatracurium(0.15mg/kg),Afentanil(10ug/kg)through the upper limb venous access.Group A2:Midazolam(0.02-0.04mg/kg),propofol(1-2mg/kg),cisatracurium(0.15mg/kg),Afentanil(20ug/kg);Afentanil was injected within 30 S in both groups.After anesthesia induction,BIS value was around 50.Endotracheal intubation was performed by visual laryngoscope,and catheter location was confirmed by auscultation,and mechanical ventilation was connected to anesthesia machine.Propofol(4-6mg/kg.h),remifentanil(0.15ug/kg.min),blood pressure and heart rate were maintained within ±20% of the basic value,BIS value was between 40-60.Cisatracurium(0.1mg/kg)was given discontinuously,and remifentanil and propofol were suspended after the operation.Observation indicators:1.Basic information of the patient: gender,age,BMI,length of operation.2.Vital signs,including mean arterial pressure(MAP),heart rate(HR)and BIS,were recorded 5min after entering the operating room(T1),2min after administration(T2),T3 and 5min after tracheal intubation(T4);3.Respiratory recovery time,eye opening time and extubation time of patients in two groups;4,bradycardia,tachycardia,hypertension,hypotension and other adverse reactions;ResultsA total of 60 patients were included in statistical analysis,and the age,gender,BMI and treatment duration of the two groups were compared,but there was no statistical significance(P > 0.05).(see Table 1);At T1,MAP and HR were compared between the two groups,and the difference was not statistically significant(P > 0.05).At T2,MAP and HR of the two groups were significantly different from T1(P < 0.05).At T3,MAP and HR in both groups were higher than those in T2,the difference was statistically significant(P < 0.05);at T3,MAP and HR in group A1 were significantly higher than those in group A2,the difference was statistically significant(P < 0.05);at T4,the difference in MAP and HR between groups A1 and A2 was not statistically significant(P > 0.05).(See Table 2,Table 3,Figure 1,2).At the time points T2,T3 and T4,the difference of BIS value between the two groups was not statistically significant(P > 0.05)(see Table 4 and Figure 3).There was no significant difference in respiratory recovery time,eye-opening time and extubation time between the two groups(P > 0.05)(see Table 5).There was no significant difference in the incidence of bradycardia and hypotension between the two groups(P > 0.05).The incidence of hypertensive tachycardia in group A2 was lower than that in group A1,and the difference was statistically significant(P < 0.05)(see Table 6).ConclusionsIn patients with esophagogastric varices treated by gastroscopy under general anesthesia,20ug/kg of afentanil during anesthesia induction of endotracheal intubation can better inhibit intubation response than 10ug/kg of afentanil during anesthesia induction of endotracheal intubation,and can make the hemodynamics of induction more stable,and has no effect on the recovery period.Does not prolong the extubation time of the patient.