Influence Of Different Depth Of Anesthesia Index On The Duodenal Motility During ERCP

Objective Although ERCP has become a mature operation technique as an important means to diagnose and treat biliary and pancreatic duct diseases,there are still problems such as difficult operation,prolonged operation time or failure due to duodenal hypermotility.In this study,the depth of anesthesia index（AI）was controlled within different ranges by adjusting the dosage of propofol,and the influence of different the depth of anesthesia index on the duodenal motility during ERCP was observed.Methods A total of 105 patients with ERCP+EST who underwent non-tracheal intubation under intravenous anesthesia from March 2021 to March 2022 were selected,aged≥18 years,ASA grade I toⅢ.They were divided into 3 groups（n=35 cases）by random number table method:AI 40-49（AI40 group）,AI 50-59（AI50 group）and AI 60-69（AI60 group）.Propofol was injected intravenously at a rate of 1.5～2.5mg/kg until the patient’s eyelash reflex disappeared,then it was changed to IV infusion pump at 4 mg/（kg·h）.The dosage was increased or decreased every 30 seconds at a gradient of 0.5mg/（kg·h）according to AI value until the target AI value was reached.The surgeon began to enter the scope.During the operation,propofol was injected with IV pump at a constant speed of 4-12 mg/（kg·h）,and the pump speed of propofol was adjusted to the required level according to AI.Duodenal motility times,grading,HR,MAP,SPO2 and RR were recorded at 5 time points after endoscopic arrival at the duodenal papilla（T0）,every 3 minutes thereafter（T1,T2,T3）and before the end of surgery（T4）.The Times of biliary intubation,the duration of biliary intubation,the operation time,the dosage of propofol,the patient’s satisfaction,the additional use of anti-peristalsis drugs during the operation,and the adverse reactions（hypotension,low oxygen saturation）were recorded.Results There were no significant differences in duodenal motility times and grades among the three groups at each time point（P>0.05）.Compared with T₀,duodenal motility times and grades in the three groups were significantly increased from T₁to T₄（P<0.05）.There were no significant differences in the number of biliary intubation,intubation time and operation time among the three groups（P>0.05）.The induced dose of propofol in AI40 group was significantly higher than that in AI50 group than that in AI60 group,and there was statistical significance（P<0.01）.Compared with AI50 group,the satisfaction of surgeons in AI40 group and AI60 group was lower and statistically significant（P<0.05）.At T₄,MAP in AI60 group was significantly higher than that in AI40 and AI50 groups（P<0.05）,but there were no significant differences in HR,SPO2 and RR among the three groups at each time point（P>0.05）.There was no significant difference in the incidence of adverse reactions among the three groups（P>0.05）.At T₀and T₄,operation exposure duration was positively correlated with duodenal motility times and grades.There was no significant difference in duodenal motility times and grades between aged≥65 years and aged<65 years（P>0.05）.Compared with T₀,duodenal motility times and grades in both groups were significantly increased from T₁to T₄（P<0.001）.There was no correlation between duodenal motility and age.Conclusion Different AI under different doses of propofol had no effect on duodenal motility during ERCP operation.The duration of surgical exposure was positively correlated with duodenal motility,that is,the longer the duration of surgical exposure,the faster the duodenal motility.