The Effects Of Different Depths Of Sedation During General Anesthesia On Postoperative Cognitive Function In Patients

Objective To investigate the effects of different depths of sedation during combinedintravenous-inhalational anesthesia on postoperative cognitive function in patientsundergoing gynecological laparoscopic surgery and explore the milder effects of depthof sedation on postoperative cognitive function.Methods Ninety ASA Ⅰo r Ⅱ patients, aged18-60yr, with a body mass index of19-30kg/m2, scheduled for elective gynecological laparoscopic operation, wererandomly divided into3groups (n=30each). group Ⅰ:BIS value at30﹤BIS value≤40,group Ⅱ:40﹤BIS value≤50, group Ⅲ:50﹤BIS value≤60. Induction of anesthesia wasperformed with dormicum(0.2mg/kg),fentanily(2μg/kg) propofol(2mg/kg) androcuronium(0.6mg/kg),then intubated tracheal catheter and ventilated(VT8～10ml/kg,RR8～12per minute, I：E=1：2, Oxygen flow2L/min, PETCO230～40mmHg).Anesthesia was maintained with inhalation of sevoflurane(the end-tidal concentration1.0%-1.5%), intravenous infusion of remifentanil and intermittent iv boluses ofrocuronium. The infusion rate of remifentanil was adjusted to maintain respectively.Stopped the inhalation of sevoflurane and remifentanil at the end of operation, thentransferred patients to the postanesthesia care unit, pulled out the tracheal catheter andsent patients to the ward until they were awake and recovered muscle strengthcompletely. Cognitive function was assessed using the Mini-Mental StateExamination(MMSE) and Trail-Making Test at1d before anesthesia and1d aftersurgery.Results1.In groups Ⅰ MMSE scores were29.0±1.1scores at1d before anesthesia,1d after surgery were29.3±0.9scores; in groups Ⅱ MMSE scores were28.9±1.1scores at1d before anesthesia,1d after surgery were29.2±1.0scores; in groups ⅢMMSE scores were29.2±1.0scores at1d before anesthesia,1d after surgery were29.5±0.7scores. There were no significant difference between two time points and among three groups (P>0.05).2. In groups Ⅰ TMT completion time were39.0±14.1s at1d before anesthesia,1dafter surgery were39.1±14.1s; in groups Ⅱ TMT completion time were39.7±15.8sat1d before anesthesia,1d after surgery were33.9±14.1s; in groups Ⅲ TMTcompletion time were40.1±12.4s at1d before anesthesia,1d after surgery were41.1±12.5s..Compared with that1d before anesthesia, TMT completion time was prolonged0.1±6.7s and1.0±6.3s at1d after surgery in groups Ⅰ andⅢ, while shortened5.8±7.9s in group Ⅱ (P＜0.05). Compared with groups Ⅰ andⅢ, TMT completion timehas significant difference in group Ⅱ (P＜0.05).Conclusion The depth of sedation,40﹤BIS value≤50, under combinedintravenous-inhalational anesthesia has milder influence on postoperative cognitivefunction in patients undergoing gynecological surgery. Objective To investigate the effects of different depths of sedation during totalintravenous TCI anesthesia on postoperative cognitive function in patients undergoinggynecological surgery and explore the milder effects of depth of sedation onpostoperative cognitive function.Methods Ninety ASA Ⅰo r Ⅱ patients, aged18-60yr, with a body mass index of19-30kg/m2, scheduled for elective gynecological laparoscopic operation, wererandomly divided into3groups (n=30each). group Ⅰ:BIS value at30﹤BIS value≤40,group Ⅱ:40﹤BIS value≤50, group Ⅲ:50﹤BIS value≤60. Induction of anesthesia wasperformed with dormicum(0.2mg/kg) and fentanily(2μg/kg), propofol using TCI model5μg/ml, then injected rocuronium0.6mg/kg when patients lost consciousness, intubatedtracheal catheter and ventilated after1min（VT8～10ml/kg, RR8～12per minute, I：E=1：2, Oxygen flow2L/min, PETCO230～40mmHg）. Anesthesia was maintained withintravenous infusion of TCI propofol and remifentanil, intermittent iv boluses ofrocuronium. The infusion concentration of propofol and remifentanil was adjusted tomaintain respectively. Stopped the intravenous infusion of propofol and remifentanil atthe end of operation, then transferred patients to the postanesthesia care unit, pulled outthe tracheal catheter and sent patients to the ward until they were awake and recoveredmuscle strength completely. Cognitive function was assessed using the Mini-MentalState Examination（MMSE）and Trail-Making Test at1d before anesthesia and1d aftersurgery.Results1.In groups Ⅰ MMSE scores were29.2±0.6scores at1d before anesthesia,1d after surgery were29.8±0.4scores; in groups Ⅱ MMSE scores were29.1±1.1scores at1d before anesthesia,1d after surgery were29.0±1.0scores; in groups ⅢMMSE scores were29.5±1.0scores at1d before anesthesia,1d after surgery were29.5±0.6scores. There were no significant difference between two time points and amongthree groups (P>0.05).2. In groups Ⅰ TMT completion time were41.5±10.5s at1d before anesthesia,1d after surgery were33.8±9.2s; in groups Ⅱ TMT completion time were43.9±22.4s at1d before anesthesia,1d after surgery were39.4±21.1s; in groups Ⅲ TMT completiontime were38.1±14.5s at1d before anesthesia,1d after surgery were38.4±9.8s.Compared with that1d before anesthesia, TMT completion time was shortened9.6±13.0s and1.8±8.6s at1d after surgery in groups Ⅰ andⅡ, while prolonged0.2±15.3sin group Ⅲ (P＜0.05). TMT completion time has no significance at1d after surgerybetween groups Ⅱand Ⅲ;compared with groupsⅡ andⅢ, TMT completion time hassignificance at1d after surgery in group Ⅰ(P＜0.05).Conclusion The depth of sedation,30﹤BIS value≤40, under total intravenous TCIanesthesia has milder influence on postoperative cognitive function in patientsundergoing gynecological surgery.