The Research On Relative Between Preoperative Pain Tolerance And Tci Sedative Dose Of Propofol

Objectives: To explore the relative between preoperative pain sensitivity and propofol target-controlled sedation, and provide information to administrate anesthetics for Individual.Methods: Sixty female patients(ASA physical statusⅠ～Ⅱ)aged 20～60,needed general anesthesia were studied.Yesterday afternoon before surgery, pain sensitivity was measured by electrical stimulation preoperatively, including pain threshold and pain tolerance; A Zung's Depression Scale and Zung's self rating anxiety scale was used to assess patients'psychological status before surgeries. After the opening upper extremity veins in patients and routine monitoring,including Electrocardiogram(ECG) and heart rate(HR),pulse oxygen saturation, arterial pressure( systolic blood pressure, diastolic blood pressure, mean arterial pressure) were recorded. Use of total intravenous anesthesia with infusion of Ringer's lactate solution intravenously at 10ml/kg before anesthesia,then maintained at 10ml/(kg.h). The effect-site concentration of propofol was set first at 1.0μg/ml, untill the target-controlled concentration in plasma and the target-controlled concentration in effect site maintained equilibrium for 3min. Then increased step by step by 0.2μg/ml, the level of sedation was assessed using OAA/S scale at 20 seconds interval until the OAA/S score reached to 1 point.Then pressurized oxygen mask immediately,and we use vecuronium 0.1ml/kg and the effect-site concentration of remifentanil was set at 4ng/ml before intubation. Patients breathed spontaneously before the spo2 dropped to 90% or the sedative depth was assessed to OAA/S point1.Recorded the blood pressure,heart,rate,spo2 respectively after the patient was sent into the operating room and calmed down for 5 min.The effect-site concentration, blood pressure, heart rate were recorded respectively when OAA/S reached to point3and point1. We use the SPSS13.0 statistics software to analyze the correlation between scores of Zung's self-rating depression scale, Zung's self-rating anxiety scale, pain threshold, pain tolerance and the effect-site concentration when sedative depth reached to point3 and point1 by using OAA/S;and to analyze the correlation between pain threshold, pain tolerance and the changes of MAP, HR ,SpO₂(OAA/S reached to point3 or point1 and base line).Results 1. Patients'psychological state (anxiety, depression) was not correlated with preoperative pain threshold and pain tolerance (P>0.05); 2. Preoperative pain tolerance not pain threshold was positive correlated with the target-controlled concentration in effect site when OAA/S reached to point3, and point1, (rpoint1=0.664, rpoint3 =0.667, P<0.05), which means the higher the pain tolerance,the higher the target-controlled concentration in effect site when sedative depth reached to point 3,point1;3. Pain tolerance had positive significant correlation with the changes of MAP, HR, SpO₂ (OAA/S 3and base line) (r =0.600, P<0.05. r =0.546, P<0.05. r =0.624, P<0.05), the changes of OAA/S 1and base line(r =0.606, P<0.05. r =0.551, P<0.05. r =0.560, P<0.05). Conclusion Preoperative pain tolerance of patients was positive correlated with the effect-site concentration of propofol when sedative depth was reached to point 3 and point 1 by using OAA/S.Pain tolerance was positive correlated with inhibition of respiration and circulation when reached to a certain depth of sedation.