| BackgroundAs a general concern of the anesthesiologists, monitoring and judging of the depth of general anesthesia is a basic problem in the subject of anesthesia, and it is also an urgent problem to be solved. Surgery and other noxious stimulation can cause the body's stress response, that is, the changes in the level of hormones in the sympathetic and endocrine system. The depth of anesthesia is actually the degree of inhibition of this reaction after the disappearance of consciousness.The ideal anesthetic state is:1, the patient's consciousness disappeared, no intraoperative awareness, no postoperative anesthesia and surgery related adverse memory; 2, intraoperative hemodynamic is stable, pain/noxious stimulation of anesthesia and operation is controlled effectively; 3, muscle relaxation is ease of operation of the surgeon; 4, adverse nerve reflex was inhibited, such as bile heart reflex, eye heart reflex, etc.;5, respiratory and circulatory functions are protected to the greatest extent, the physiological functions of the patients recovered quickly and completely after the operation. Only by accurately monitoring and judging the depth of anesthesia, can the patients achieve the ideal state of anesthesia.The judgment method based on the observation of the clinical vital signs and the judgment method based on the anesthesia monitoring equipment are two main ways of the judge of the depth of anesthesia. There is anesthesia monitoring equipment such as bispectral index, entropy of the EEG, Narcortrend, auditory evoked potential, event-related potential, positron emission computed tomography and functional magnetic resonance imaging. But because of the monitoring principle, limitation and economy of the equipment, there is no ideal device that can be used to monitor the depth of anesthesia.Bispectral index which is widely used at present can reflect the excitement and inhibition of cerebral cortex function, and it is a sensitive and objective quantitative index to evaluate the state of consciousness. But bispectral index mainly reflects the sedative effect produced by propofol, etomidate and inhaled anesthetics which inhibit the cerebral cortex, and the monitoring of the analgesic effect of general anesthesia is poor.Indexes of consciousness is a new type of anesthesia depth monitoring technique. It is based on the comprehensive analysis of the OAAS and RASS values of the patients undergoing general anesthesia. IoC1 which represents the sedation index, was used to guide the use of propofol, and IoC2 which is on behalf of the analgesia/anti injury index, was used to guide the use of remifentanil.It was found that the dosage of propofol and remifentanil in patients undergoing chemotherapy before surgery was different from that in patients who did not receive preoperative chemotherapy in the first part of the study. Therefore, the second part of this study was to discuss the effects of preoperative chemotherapy on the anesthesia sensitivity of patients with breast cancer.The first part of this study was to investigate the effects of indexes of consciousness (IoC1 and IoC2) monitoring on propofol and remifentanil dosage of patients undergoing unilateral modified radical mastectomy during total intravenous anesthesia. The second part of this study was to investigate the effects of preoperative chemotherapy on the anesthesia sensitivity of patients undergoing unilateral modified radical mastectomy during total intravenous anesthesia.PART?Effects of indexes of consciousness (IoCl and IoC2) monitoring on propofol and remifentanil dosage of patients undergoing unilateral modified radical mastectomy during total intravenous anesthesia.Objective:The first part of this study was to investigate the effects of indexes of consciousness (IoC1 and IoC2) monitoring on propofol and remifentanil dosage of patients undergoing unilateral modified radical mastectomy during total intravenous anesthesia.Methods:120 patients undergoing elective unilateral modified radical mastectomy during total intravenous anesthesia were selected. They were randomly assigned to the treatment group (T group, n= 60) or the control group (C group, n= 60) according to the random number card generated by the SPSS17.0 statistics software. All patients underwent routine noninvasive blood pressure (NBP), electrocardiogram (ECG), pulse oxygen saturation (SpO2), pressure of end-tidal carbon dioxide(PETCO2) monitoring. In the T group, patients received both IoCl (sedation) and IoC2 (analgesia/anti injury) monitoring, and propofol and remifentanil dosage were adjusted by anesthetists according to IoC1 and IoC2. In the C group, propofol and remifentanil dosages were adjusted based on the anesthetists'judgment according to the patients'vital signs such as blood pressure and heart rate, with the fluctuation is less than or equal to 20% baseline values as a reference. Adjustment frequency of propofol, infusion duration of propofol, mean propofol dosage, adjustment frequency of remifentanil, infusion duration of remifentanil, mean remifentanil dosage, intraoperative adverse events(hypertension, hypotension, tachycardia, bradycardia, body movements and intraoperative awareness), and quality of anesthetic recovery(voluntary eye opening time, extubation time and awakening score) were compared between the two groups.Results:Compared with the C group, mean remifentanil dosage was significantly higher in the T group (285±36 versus 203±19 ?g, P< 0.05) during the anesthetic period, as was the adjustment frequency of target-controlled infusion of remifentanil(2.9±1.9 versus 2.0±1.2 times/surgery, P< 0.05), but there was no difference in infusion duration of remifentanil. Adjustment frequency of propofol, infusion duration of propofol, mean propofol dosage, voluntary eye opening time, extubation time, and recovery score were not significantly different between the two groups (P> 0.05). Total adverse events[26 (48%) vs 36 (68%), (P<0.05)] were significantly reduced in the T group.Conclusions:IoCl-targeted propofol dosing did not seem to be significantly different to hemodynamic-based monitoring, whereas IoC2 monitoring could increase mean remifentanil dosage during modified radical mastectomy, but the anesthetic process was more controllable and total adverse events were reduced, which improved the controllability of anesthesia.PART?Effects of preoperative chemotherapy on the anesthesia sensitivity of patients undergoing unilateral modified radical mastectomy during total intravenous anesthesia.Objective:The second part of this study was to investigate the effects of preoperative chemotherapy on the anesthesia sensitivity of patients undergoing unilateral modified radical mastectomy during total intravenous anesthesia.Methods:90 patients undergoing elective unilateral modified radical mastectomy during total intravenous anesthesia were selected. They were assigned to two groups:preoperative chemotherapy group (PC group, n=45) or non preoperative chemotherapy group (nPC group, n=45). In addition to conventional noninvasive blood pressure (NBP), electrocardiogram (ECG), pulse oxygen saturation(SpO2), pressure of end-tidal carbon dioxide(PErCO2) monitoring, indexes of consciousness (IoCl and IoC2)monitoring was implemented in the two groups. And propofol and remifentanil dosage was adjusted by anesthetists according to IoCl (sedation) and IoC2(analgesia/anti injury), to control the fluctuation of blood pressure and heart rate within 20%of baseline values as a reference. Adjustment frequency of propofol, infusion duration of propofol, mean propofol dosage, adjustment frequency of remifentanil, infusion duration of remifentanil, mean remifentanil dosage, intraoperative adverse events(hypertension, hypotension, tachycardia, bradycardia, and intraoperative awareness), and quality of anesthetic recovery(voluntary eye opening time, extubation time and awakening score) were compared between the two groups.Results:Compared with the nPC group, the adjustment frequency of target-controlled infusion of propofol (2.0±.0 versus 2.7±1.5 times/surgery, P< 0.05), mean propofol dosage (732±65 versus 921±74mg, P< 0.05), the adjustment frequency of target-controlled infusion of remifentanil (2.9±1.8 versus 4.4±2.6 times/surgery, P<0.05) and mean remifentanil dosage(201±32 vs 270±41?g, P< 0.05) in the PC group were significantly lower; Infusion duration of propofol, infusion duration of remifentanil, voluntary eye opening time, extubation time, and recovery score were not significantly different between the two groups (P> 0.05); The incidence of bradycardia in the PC group was lower than that in the nPC group [4 (9.7%) vs 7 (17.5%), P<0.05], but there was no significant difference in the incidence of total adverse events between the two groups.Conclusions:For the breast cancer patients who received preoperative chemotherapy, the adjustment frequency of target-controlled infusion of propofol, mean propofol dosage, the adjustment frequency of target-controlled infusion of remifentanil and mean remifentanil dosage were significantly decreased during total intravenous anesthesia, but the quality of anesthetic recovery and total intraoperative adverse events were not significantly different, indicating that preoperative chemotherapy can enhance the patients' sensitivity to propofol and remifentanil during total intravenous anesthesia. |
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