The Effect Of The Different Doses Of Sufentanil In Propofol Anesthesia On The Incidence Of Postoperative Delirium

Objective Delirium is an acute mental disorders of brain, accompanying by consciousness and cognitive dysfunction.. The main clinical manifestations is mainly with agitation, and the character is the increased awareness, a high degree of vigilance and obviously agitated of the surrounding environment, and also is mainly with the spiritual depression,such as it is not easy to wake up, weak and feeble. The incidence of postoperative delirium is high, especially in the elderly. Postoperative delirium could influence seriously the recovery of patients, and reduce the quality life of patients after operation, so the related research has been paid more and more attention.Some studies had shown that, using sufentanil after the operation has a role in the treatment of postoperative delirium. However, the research of sufentanil and postoperative delirium is scarce. The purpose of this paper is to explore the effect of the different doses of sufentanil in propofol anesthesia on the incidence of postoperative delirium.Methods Chose90patients in our hospital for elective laparoscopic cholecystectomy under general anesthesia with ASA of grade I-II. According to the random number table, the patients were divided into three groups (n=30):group A (0.4μg/kg sufentanil were administered during anesthesia maintenance); group B (0.5μg/kg sufentanil were administered during anesthesia maintenance); group C (0.6μg/kg sufentanil were administered during anesthesia maintenance). The target controlled concentration of propofol was set up at3ug/ml for each group. Recorded the HR, MAP of each patient when before entering the operation room (TO), at the beginning of the operation (T1), at the end of operation (T2),after the tracheal catheter pulling(T3),10min after the tracheal catheter pulling(T4). And recorded the time of extubation. The time of extubation was form the operation stopping to pulling out the tracheal catheter. Also recorded the postoperative pain score, the incidence of postoperative delirium and respiratory inhibition. The decannulation indications was tidal volume>350ml, SpO2maintaining in more than92%, and the patients can follow the doctor’s instructions to complete shook his head and open action. Graded for each patient use the Price-Henry method. Recorded the Price-Henry pain score when1hours after the operation,4hours after the operation,24hours after the operation and48hours after the operation. The incidence of postoperative delirium was evaluated using the Confusion assessment method-Chinese Revised (CAM-CR) within three days after operation. The incidence of respiratory inhibition was recorded after operation in each group.Results Compared with TO in each group, the HR and MAP of groupA had no significant change in T1and T2(P>0.05). The HR and MAP in T3and T4went up obviously (P<0.05).The HR and MAP of groupB and groupC have no obvious difference in each time point (P>0.05). The HR and MAP of three groups had no significant change in T0, T1and T2time points.In group B and group C, the MAP and HR were significantly lower than group A in T3and T4(P<0.05). The extubation time were different between the three groups. Compared with group A, Price-Henry pain score of patients in group B and group C was lower in the1h,4h,24h,48h after operation(P<0.05). And the Price-Henry pain score of patients in group C is lower than group B(P<0.05). The incidence of postoperative delirium were different between the three groups. The incidence of postoperative delirium of group C was lower than group B and group B was lower than group A (P<0.05).All patients had no reflux, respiration amnesia and hypoxia after operation.Conclusion Different doses of sufentanil in propofol anesthesia can reduce the incidence of postoperative delirium. The effect is dose related. With the increase of sufentanil dose, the effect of prevention of postoperative delirium was also increased.