Application Of Bispectral Index Combined With Muscle Relaxation Monitoring In Robot-assisted Laparoscopic Radical Prostatectomy

Objective Within this past years,the introduction of the da Vinci Surgical System has solved some of the limitations of traditional laparoscopic urology.During the surgical procedure,pneumoperitoneum and the steep Trendelenburg have a great influence on patients' vital signs and postoperative delirium.In this study,we mainly observed the effect of bispectral index combined with muscle relaxation monitoring on vital signs and postoperative delirium in patients undergoing robot-assisted laparoscopic radical prostatectomy.Methods One hundred elderly patients who underwent robot-assisted laparoscopic radical prostatectomy were randomly allocated into BIS and muscle relaxation monitoring groups?AA,n=50?and control groups?AC,n=50?.In groups AA,propofol was infused to achieve the BIS value of 40-60,and we monitored the muscle relaxation to conduct closed-loop infusion of cisatracurium.In groups AC,we regulated the depth of anesthetic with the patients' vital signs according to anesthetists' experience.Mean arterial pressures?MAP?,heart rates?HR?,airway platform pressure?PPlat?,and airway peak pressure?PPeak?,PETCO2 and blood gas analysis results were recorded at following time points: before anesthesia induction?T₀?,after anesthesia induction?T₁?,ten minute?T₂?,thirty minute?T₃?and sixty minute?T₄?after artificial pneumoperitoneum,and the end of operation?T₅?.We recorded the dose of propofol,cisatracurium,sufentanil,remifentanil,vasoactive agent,extubation time,PACU stay time,gastrointestinal function recovery and hospital stay time.To assess whether patients with delirium,performed Ramsay sedation score and visual analogue pain score at the following time points: two,twenty-four,forty-eight and seventy-two hours after surgery.Blood samples were collected before and immediately after operation,first and the fifth day after operation,to detect the levels of interleukin-6?IL-6?,serum tumor necrosis factor alpha?TNF-??and S-100?.Results?1?General clinical data: there was no significant difference?P?0.05?between two groups on general clinical data,surgery and anesthesia time,blood loss and fluid volume;?2?At T₁?T₂ and T₅,the MAP and HR of groups AC were significantly higher than groups AA?P?0.05?;at T₃ and T₄,the MAP of groups AC were apparently lower than groups AA?P?0.05?but HR hadn ' t change obviously.Compared with T₀,the MAP and HR of groups AC were significantly increased at T₁ ?T₂ and T₅?P?0.05?,the MAP of groups AC were obviously reduced at T₃ and T₄?P?0.05?,the MAP and HR of groups AC were also fluctuated obviously at different time points.Compared with T₀,the MAP and HR of groups AA at points T₁-T₅ had no statistically significant differences?P?0.05?and the fluctuation of MAP and HR were smaller.?3?Compared with T₁,PPlat and PPeak of the two groups were significantly increased at T₂-T₅?P?0.05?.PPlat and PPeak of grpups AC were higher than groups AA at T₂-T₄?P?0.05?.?4?In both groups,the PETCO2 were increased significantly and the p H were decreased significantly at T₂-T₅?P?0.05?.?5?Compared with groups AC,the dose of propofol and cisatracurium were less in groups AA?P?0.05?.There was no significant difference in the number of patients treated with vasoactive drugs?P?0.05?.?6?Compared with groups AC,the postoperative extubation time,PACU stay time,gastrointestinal function recovery and hospital stay time were shorter in groups AA?P?0.05?.?7?Compared with AC groups,the incidence of delirium at 2h and 24 h after surgery of AA groups significantly reduced?P?0.05?.?8?Compared with preoperation,the serum levels of IL-6,TNF-alpha,S-100 beta in the two groups were significantly higher in the immediate postoperative period,1d and 5d after surgery.Compared with the AA groups,the serum IL-6,TNF-alpha,S-100 beta concentrations in the AC groups were significantly higher in the immediate postoperative period,1d and 5d after surgery.Conclusion Application of BIS and muscle relaxation monitors in robot-assisted laparoscopic radical prostatectomy can reduce hemodynamics and airway pressure fluctuation,and the dose of anesthetics.Meanwhille,this anesthesia management method also shorten the extubation time,the PACU stay time,gastrointestinal function recovery and hospital stay time,which improved the anesthesia recovery quality,reduced the incidence of delirium and promoted rapid postoperative rehabilitation.