Effects Of Dexamethasone On The Narcotrend And S100βprotein Of Patients Undergoing Laparoscopic Colorectal Cancer Radicaln Opetration In Trendelenburg Position In The Postoperative Period

The history of surgery is long-standing and well-established.Since the human civilization,the surgery was born.But in the 1840 s,the development of the surgery was almost stagnant.Surgery has been the development of the revolutionary,since the anesthesia,aseptic operation,antibiotics,blood transfusion and other key problems was solved.Since the 1970 s,the minimally invasive technology has come into people’s horizons and has been widely accepted by the surgeon now.As a result of the development of minimally invasive techniques,the concept of "Laparoscopic Colorectal cancer radicaln opetration " had the earth-shaking change,from "Gold standard operation"-abdominal perineal resection in the past to protect anal operation now.The concept of minimally invasive have successfully into the surgical technique.Minimally invasive technology compared with traditional surgical techniques,the influence of environment inside the body is very small,for patients with less trauma,reduce health care costs and so on.But any art has its limitations and shortcomings.Minimally invasive surgery has a lot of problems,such as the problem of carbon dioxide pneumoperitoneum,special position,the decrease of dexterity also caused people’s attention.In the Laparoscopic Colorectal cancer radicaln opetration,for the exposure of surgical field,we all need Trendelenburg position.This Special position is one of the reasons of patients with pathological physiology change perioperative period.Shu-hua xie professor’s studies have shown that in the time of Trendelenburg position,the numerical of MAP,JBP,Pjv02,Sjv02 were elevated compared with the hypothesis,with the degree of angle was bigger,the numerical was rised.This suggested that In the Laparoscopic Colorectal cancer radicaln opetration,following the degree of angle was bigger,the influence of body position for patients was greater.Because the time of Trendelenburg position is too long,this could cause intracranial hypertension,hydrocephalus cause even the damaged of the respiratory function and circular function.The edema of conjunctiva,throat and tongue could cause the upper respiratory tract obstruction.Dexamethasone as a classic of glucocorticoid,a large number of studies have shown that dexamethasone have a role of brain edema and brain protection.By means of stabilize the cell membrane,anti-free radical effects and diuretic action,dexamethasone could reduce intracranial pressure,relieve cerebral edema.In the period of anesthesia recovery period,in the judgment of the recovery of patients with consciousness,the traditional GCS(Glasgow Coma Scale)which was invented in 1974 is difficult to objectively reflect the patient’s state of consciousness.Narcotrend is a new-type anesthesia/electroencephalogram depth monitoring system which through the inspection of FDA(Food and Drug Administration)in 2000.It through the method of Narcotrend index(NI)from 0-100 to show the awareness state from general coma to fully awake.In the period of anesthesia recovery period,Narcotrend could reflect the patient’s state of consciousness more objective and more specific.It provides a reference for anesthetist in the period of anesthesia recovery,shorten the anesthesia awakening period,improve the quality of awakening.Narcotrend compact system uses common electrodes,the price is very cheap,monitoring the original EEG,flexible application,but the research reported about narcotrend in the period of anesthesia recovery is little.PurposeThe major purpose of this study is to research the effects of dexamethasone on the quality of awakening period in Trendelenburg position in the postoperative period.Application of Narcotrend monitoring consciousness to make an objective evaluation of the recovery of patients.Discusses the application of dexamethasone in laparoscopic assisted colorectal cancer radical possibilities.Understanding of dexamethasone adversary the prevention and cure of cerebral edema caused by Trendelenburg position.Provide a reference for anesthesia and surgeon.Methods and materials1 SubjectAfter making the patient and family to agree and through the medical ethics committee approval,58 ASA statusl or III patients undergoing Laparoscopic Colorectal cancer radicaln opetration by total intravenous anesthesia were enlisted for this study.These patients were divided into two groups at random,the control group(group A,n=29)and the dexamethasone group(group B,n=29).2 MethodsAfter the patients into the operating room,patients were established effective and reliable venous channel,monitored of noninvasive blood pressure,ECG,peripheral oxygen saturation,Narcotrend monitoring,pressure measure by arteria radialis puncture.Patients were implemented general anesthesia induction according to patients’ weight.during the operation,anesthesia was induced with target-controlled infusion of propofol with a scheduled plasma concentration of 3.5ug/ml.In the process of operation,we kept the NI on D levels.(A-waking state B-light sleep C-light anesthetized D-general anesthesia E-deep anesthesia F-burst suppression).After Trendelenburg position for 30 min,2ml normal saline were given through venoclysis in group A.At the same time,10mg dexamethasone were given in the same way in group B.30 minutes before the end of surgery,both of the group received a bolus intravenous administration of 40mg Parecoxib Sodium.Before patient’s skin was sutured,we stop the infusion of all the drugs.3 Monitor and evaluation3.1 Demographic data,sex,age,weight,the time of Trendelenburg position,blood loss,fluid volume,urine volume,the concentration of S100βprotein 8 hours after surgery were recorded.3.2 The time of NI changed from D to A in the period of anesthesia recovery.4.Statistical analysisStatistical computations were performed using SPSS 17.0 for Windows software(SPSS Inc.,Chicago,Ⅲ.,USA).Categorial variables were compared using Pearson’s X2 test.The measurement data were presented as means±SD.Two independent samples t-test was used to test the measurement data difference between groups,P<0.05 was.considered to be statistically significant.Results1 Between two groups,there was no statistically significant differences in Demographic data,sex,age,weight,the time of Trendelenburg position,blood loss,fluid volume,urine volume.2 The concentration of S100βprotein 8 hours after surgery,There were statistically significant differences between the group A and the group B3 In the dexamethasone groups,the time of NI changed from D to A were significantly shorter than the ones in the control groups.There were statistically significant differences between the group A and the group B.Conclusions1 In the Laparoscopic Colorectal cancer radicaln opetration,dexamethasone could reduce intracranial pressure,relieve cerebral edema.2 In the period of anesthesia recovery period,the application of Narcotrend could reflect the patient’s state of consciousness more objective.With the help of Narcotrend,anesthetist could Shorten the time of anesthesia recovery.