Efficacy Assessment Of Transcutaneous Electrical Acupoint Stimulation Combined Target Controlled Infusion In Anaesthesia Of Partial Mastcctomy

BackgroundEver since its application in clinical practice, the acupuncture anesthesia promots the development of clinical anesthesia. With the perfection of acupuncture anesthesia, the transcutaneous electrical acupoint stimulation (TEAS), one of the main means of acupuncture anesthesia, has been widely applied because of its simple operation, definite effect, convenience and safety. It is worthy of a further research. Most of the current researches are focused on the analgesia mechanism of TEAS, or its stimulation parameters (frequency and strength), rather than its effectiveness. In our pilot studies we got that the TEAS has a strong analgesia action and a synergistic effect with sedation drugs. It needs further researches to objectively evaluate its performance in analgesia and sedation, and to explore a more effective acupoint combination in surgery. This research focuses on a comprehensive evaluation of the performance of TEAS, combined with the target infusion technology (TCI), in breast surgeries through analyzing changes of the bispectral index (BIS) and the plasma hormone (Ad,β-EP), finding out the best combination of acupoints, the optimal dosage of tranquilizer and antalgics in breast surgery, providing evidences for clinical usage of acupuncture combined anesthesia.ObjectiveTo evaluate the facilitative effects of transcutaneous electrical acupoint stimulation (TEAS) on propofol-fentanyl anesthesia in partial mastcctomy.MethodsNinety patients undergoing partial mastcctomy in Guangdong provincial hospital of TCM were included and randomly divided into 3 groups by computer program (n=30). Group A:Anesthesia with propofol and fentanyl (control group). Target control infusion of propofol and fentanyl, propofol infusion is 3 u g/ml and fentanyl infusion is 2μg/kg at begin for each patient, target level of propofol and fentanyl is adjusted according to BIS(55±5)and no body movement during operation. Group B:TEAS (homolateral HeGu acupoint, NeiGuan acupoint) plus control group. Group C:TEAS (homolateral HeGu direct to LaoGong acupoint, NeiGuan direct to WaiGuan acupoint, bilateral Jianjing acupoints) plus control group. All these patients were ASA classⅠ～Ⅱ, aged between 20 to 65 years, female, no mental disorder, no longtime use of sedatives or drug abuse history, no liver or kidney functional abnormality.Blood pressure, Saturation of pulse oxygen (SpO2), electro-cardiogram and bispectrial index(BIS) were continuously monitored after patients entered operation room. TEAS were conducted for each patients in group B and C usque ad surgery finished. Bispectrial index (BIS), heart rate (HR), Saturation of pulse oxygen (SpO2), mean arterial pressure (MAP), the reaction of patients during operation and awakening quality were observed at following time point:T1(before TEAS for group B and C, enter operation room for group A), T2 (30min after TEAS for group B and C,30min after T1 for group A),T3(5min after anesthesia induction), T4(10min after anesthesia induction), T5(5min after incision), T6(surgery finished), T7(palinesthesia time). Ramsay depth of sedation score were evaluated before the induction of anesthesia. Blood specimen were collected from the dorsal artery of the foot for detection of plasma Adrenaline and Beta-endorphin levels by using the euzymelinked immunosorbent assay at these time point:T1, T2, T5and T7.Result1.Age, weight, cases and operation duration among three groups are not significantly different (P>0.05)2. BIS at T1 are not significantly different among three groups (P> 0.05) At T2, BIS in group B are lower than group A (P<0.05), BIS in group C are lower than group B (P<0.05); BIS at T3 to T6 decrease apparently but not significantly different among three groups (P>0.05); At T7, BIS in group B are higher than group A (P<0.05), BIS in group C are higher than group B (P<0.05) 3. Ramsay depth of sedation score at t1 is 2 for each patient; At t4, Ramsay depth of sedation score in group B and C increase compare to group A (P<0.05) group C is higher than group B (P<0.05); At T2 and T3, Ramsay depth of sedation score are not significantly different among three groups (P>0.05)4. MBP and HR at T1 are not significantly different among three groups (P>0.05); At T2, MBP and HR in group B are lower than group A (P<0.05) MBP and HR in group C is lower than group B (P<0.05); At T5, HR in group B and C are lower than group A (P<0.05), but the difference between group B and C are not significantly (P>0.05);At T3, T4, T6, T7, the differences of HR among three groups are not significantly (P>0.05); MBP at T3 to T7 are not significantly different among three groups (P>0.05)5. Before anesthesia induction, propofol infusion is 3μg/ml for each patients. For maintaining BIS between 55±5, target infusion amount of propofol are significantly different among three groups (P<0.05). Group B is lower than group A, group C is lower than group B (P<0.05, respectively)6. Total amounts of propofol and fentanyl are significantly different among three groups (P<0.05). Group B is lower than group A, group C is lower than group B (P<0.05, respectively)7.β-EP at T1 are not significantly different among three groups (P> 0.05); At T2 and T7, change ofβ-EP level in group A are not significant (P>0.05),β-EP in group B is higher than group A (P<0.05),β-EP in group C are higher than group B (P<0.05). Changes of Adrenaline level in three groups are not significantly different (P>0.05)Conclusion1. TEAS could strengthen the effective of analgesia. It has synergistic effect on sedation. It could facilitate analgesia effect of propofol-fentanyl anesthesia and has auxiliary function.2. TEAS leads to a considerable increase ofβ-EP in blood, while there is no obvious changes in the levels of Adrenaline.3. TEAS (homolateral HeGu direct to LaoGong acupoint, NeiGuan direct to WaiGuan acupoint, bilateral Jianjing acupoints) is one of satisfactory assist method for anesthesia in partial mastcctomy.