Clinical Research On Anaesthesia Effect Of Etomidate In Ear-nose-throat Surgery Including Induction And Maintenance

Objective:To estimate the effectiveness of etomidate fat emulsion in induction and maintenance for ear-nose-throat surgery.Methods:60 patients scheduled for operation with TIVA were divided into three groups according to different medication:group EE, grouP EP and group PP, n=20 for every group. Induction, group EE with etomidate 0.5mg.kg-1 and group EP with etomidate 0.4mg.kg-1,group PP with propofol 1.5mg.kg-1 All groups combined with remifentanil 1.5μg.kg-1 and ciscisatracurium 0.15mg.kg-1. The patients in group EE was maintained with etomidate in 0.3～1.2mg.kg-1.h-1, the Patients in group EP and group PP with propofol in 6～12mg.kg-1.h-1. All the patients were combined with proper amount of remifentanil and ciscisatracurium. Observed cardiovascular effects, changes and record systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) before anesthesia, in the time of lowest value after induction, instantly of intubate, at lmin,2min,3min and 5min after intubation, instantly of cutting skin, 5min, 10min,20min and 30 min after cutting skin,1,3 and 5 min after drug withdrawal, instantly of extubate,1 min and 3 min after extubation and time of living the operating room. Record how many minutes need when the patients open the eyes, being extubated and orientation recovery after drug withdrawal. Results:All the Patients have same stabilized hemodynamics meeting the requirement of surgery,(1)intra-group comparison:SBP, DBP and MAP of group PP in the time of lowest value after induction,instantly of intubate, at 1min,2min,3min and 5min after intubation are lower than basic value (P<0.05). HR of group PP instantly of intubate is lower than basic value (P<0.05). SBP,DBP of group EP in the time of lowest value after induction,instantly of intubate, at 1min,2min,3min and 5min after intubation are lower than basic value (P<0.05). MAP of group EP in the time of lowest value after induction, instantly of intubate are lower than basic value (P<0.05). HR of group EP in the time of lowest value after induction and 5min after intubation are lower than basic value (P<0.05). SBP,DBP and MAP of group EE in the time of lowest value after induction,instantly of intubate, at 1min,2min,3min and 5min after intubation are lower than basic value (P<0.05). HR of group EE instantly of intubate and 5min after intubation are lower than basic value (P<0.05).(2)comParison between groups:SBP, DBP, MAP and HR of the three groups indistinctive (P>0.05). DBP and MAP of group EE is higher than group PP (P<0.05) in the time of lowest value after induction. SBP of group EE is higher than grouP PP (P<0.05) 1 min after intubate. SBP of grouP PP in the time of lowest value after induction, at 1min and 5min after intubation lower than grouP EP (P<0.05).DBP of group PP in the time of lowest value after induction and MAP in the time of lowest value after induction,1 min after intubate lower than group EP (P<0.05). SBP of grouP EE is higher than grouP PP (P<0.05) at 20 min after cutting skin. SBP and MAP of group EE instantly of extubate and SBP 3 min after extubation lower than group PP (P<0.05).One in grouP EE restlessness during recovery and relieved in 10 min with fentanyl 0.1 mg. No intraoPerative awareness all of the 60 Patients.Conclusions:Induct with etomidate 0.5mg.kg-1 combined with remifentanil 1.5μg.kg-1 and ciscisatracurium 0.15mg.kg-1 hemodynamic more stability than propofol 1.5mg.kg-1.Continuous infusion of etomidate combined with remifentanil and ciscisatracurium kePt hemodynamic stability in while meeting the requirement of ear-nose-throat surgery.Continuous infusion of remifentanil after stopping etomidate is good for prevent restlessness during recovery.Pre-injection of midazolam and low dose etomidate are good for prevention side effect of etomidate.Maintained with etomidate is cheaper than propofol.