Comparison Of The Effect Of Closed-loop Target Controlled Infusion Of Propofol And Intravenous Infusion Of Dexmedetomidine In Epidural Anesthesia

Objective:To explore the effects of the closed-loop target controlled infusion of propofol and intravenous infusion of dexmedetomidine on epidural anesthesia,such as sedative effects,hemodynamics and related adverse reactions.Methods:A total of sixty patients of ASA(American Society Anesthesiologist)physical status I or II who underwent single Saphenous vein stripping surgery were enrolled into the study.Patients were randomly divided into two groups:closed-loop target controlled infusion of propofol group(group P,n=30)and dexmedetomidine group(group D,n=30).All patients received phenobarbital 100mg and atropine 0.5mg intramuscularly in the wards as pre-medication.On arrival in the surgery room,all of the patients were monitored with the electrocardiogram(ECG),non-invasive arterial blood pressure(MAP?SBP?DBP),heart rate(HR),oxygen saturation(Sp02),bispectral index(BIS).An epidural catheter was inserted into L3-L4 vertebral interspace.And using 0.5%ropivacaine during the surgery to maintain the anesthesia plane.Patients in group D received 0.8ug/kg of dexmedetomidine intravenously,10min,then followed by 0.4ug/kg/h continuous input,20min before the end of the surgery to stop.Patients in group P received the closed-loop target controlled infusion of propofol.Set the initial plasma concentration as 0.6ug/ml,adjusted amplitude as 0.2ug/ml.Set BIS value from 60 to 80,using BIS value as feedback variable.Adjust the plasma concentration of propofol automatically to maintain the target BIS value.10min before the end of surgery to stop.Record MAP,HR,SpO2,BIS,alertness/sedation score(OAA/S)and adverse reactions at the time point,patients enter the operating room(T0),before intravenous infuse the sedative drugs(T1),skin incised(T2),30min after the surgery(T3),60min after the surgery(T4),90min after the surgery(T5),the end of the surgery(T6),before patients left the surgery room(T7).Record the condition of using sufentanil that because of inadequate analgesia at the same time.Result:1.There were no significant differences between the two groups with age,weight,height,ASA,and gender distribution.2.MAP of the two groups were significantly lower at T1?T7 than T0(P<0.05);The group P's MAP at T2?T5 were decreased more significantly(P<0.05).3,HR of the two groups at T1?T6 were significantly lower than T0(P<0.05),HR of group D decreased more significantly than group P at T2?T6,the differences were statistically significant(P<0.05),4.The two groups of patients were both able to achieve a satisfying level for sedation.At T2?T7,the BIS values and OAA/S scores were significantly lower than TO(P<0.05),the differences were statistically significant(P<0.05).BIS values of group D were lower than group P at T2?T6,the differences were statistically significant(P<0.05);OAA/S scores of group D were higher than group P at T2?T6,the differences were statistically significant(P<0.05).5.Comparing the two groups,the incidence of hypotension in group D was significantly lower than that in group P(P<0.05).There were no significant differences with the other adverse reactions between the two groups(P>0.05).6.Neither of the patients used sufentanil on account of inadequate analgesia.Conclusion:Closed-loop target controlled infusion of propofol and intravenous infusion of dexmedetomidine can provide satisfactory sedation for epidural anesthesia,respiratory depression,nausea and vomiting and other related adverse reactions have no significantly differences.Compared to both,intravenous infusion of dexmedetomidine has a greater advantage in hemodynamic stability.