Comparison Of Clinical Application Of Butorphanol And Fentanyl Under Total Intravenous Anesthesia

Objective To evaluate the effect of clinical application of butorphanol under total intravenous anesthesia, to compare with fentanyl, discuss the security and feasibility of clinical application of butorphanol under total intravenous anesthesia.Methods One hundred and twelve patients scheduled for selective Thyroid, Breast surgery operation under total intravenous anesthesia, ASAⅠ-Ⅱ,aged25-55, weight50-70kg, height150-178cm ,were randomly divided into four groups: Contrast Group (Group C),Fentanyl Group (Group F),Butorphanol Group(Group B),Butorphanol and Fentanyl Group(Group BF),each twenty-eight. All the groups started target controlled infusion of propofol at the initial plasma concentration(Cp) 4.0μg/ml,the consciousness disappeared when BIS went below 55. Group C,started target controlled infusion of propofol, after the consciousness disappeared fentanyl was given 4μg/kg and cis-benzene atracurium 0.2mg/kg,inserted endotracheal tube , connected it to the anesthesia machine and began mechanical ventilation. Group F were given fentanyl 4μg/kg, two minutes later started target controlled infusion of propofol, after the consciousness disappeared, cis-benzene atracurium was given 0.2mg/kg, inserted endotracheal tube , connected it to the anesthesia machine and began mechanical ventilation. Group B were given butorphanol 40μg/kg, five minutes later started target controlled infusion of propofol, after the consciousness disappeared, cis-benzene atracurium was given 0.2mg/kg, inserted endotracheal tube , connected it to the anesthesia machine and began mechanical ventilation. Group BF were given butorphanol 20μg/kg five minutes before anesthesia induction and fentanyl 2μg/kg two minutes before anesthesia induction, started target controlled infusion of propofol, after the consciousness disappeared, cis-benzene atracurium was given 0.2mg/kg, inserted endotracheal tube, connected it to the anesthesia machine and began mechanical ventilation. For the four groups BIS,NBP,HR were refered to, to regulate the plasma concentration of propofol and the infusion rate of remifentanil, to maintain appropriate depth of anesthesia. When the operation was going to complete, reduced and stopped the infusion of propofol and remifentanil appropriately. After the patient regained consciousness, pulled out the endotracheal tube when there were indications for extubation. Put down the Bispectral index for each corresponding effect site concentration (Ce) when anesthesia induction was in progress, to draw corresponding line chart. Recorded NBP,HR: the basis ones(T0),the ones after induction(T1),the ones 1min(T2),5min(T3),10min(T4) after endotracheal tube was inserted. Took down the awake time,the extubation time, and pain score,sedation score and restlessness score 30min after endotracheal tube was pulled out. Revisited the patients after operation the next day, to observe the adverse reactions.Results At each corresponding effect site concentration, the Bispectral index of Group B and Group BF was lower than that of Group C and Group F, there was significant difference. The sequence that the four groups fulfilled the sedation level that operation demanded: Group B, Group BF, Group F and Group C;There was significant difference between Group B, Group BF and Group C, Group F;Also between Group B and Group BF. There was no significant difference for the awake time,extubation time and restlessness score 30min after endotracheal tube was pulled out. The pain score,sedation score of Group B and Group BF was better than that of Group C and Group F, there was significant difference. Group B and Group BF had less adverse reactions such as swirl, nausea, throw up, respiratory depression and shiver than that of Group C and Group F, there was significant difference. As for other adverse reactions: In Group C one had poor sleep, one swelling eyes. In Group F one had distensible abdomen. In Group B one had a headache, one palpitation, one sudation and one had foreign body sensation in eyes. In Group BF three had a headache, one itch, one stomachache, one hunger.Conclusion Butorphanol is safe and feasible to be applied to total intravenous anesthesia, it deserves generalizing.