Effect Of Different Level Of BIS On TNF-? And IL-6 In Elderly Patients Undergoing Resection Of Gastrointestinal And Clinical Observation

Objectives To observe different values of TNF-? and IL-6 with elderly patients undergoing gastrointestinal tumor surgery by different levels of BIS and the quality of recovery after operation;to investigate the effects on inflammatory reaction and the quality of recovery the operation by different depths of anesthesia sedation;to provide a proper depth of anesthesia sedation for elderly patients.Methods 1 From December 2015 to May 2016,sixty elderly patients?aged 65 ⁷5,32 males,28 females,American Society of Anesthesiology ? ? level?from The Affiliated Hospital of North China University of Science and Technology,who were scheduled to receive gastrointestinal tumor surgery,were randomly divided into Group L?BIS 50⁵9?and Group D?BIS 40⁴9?according to random number table,each group for 30 cases.2 All patients did not use preoperative medication,all adopted the same anesthesia program and monitored by ECG,HR,Sp O2 and BIS.Performing radial artery puncture and internal jugular vein puncture through local anesthesia,is aimed to respectively monitor IBP and CVP.During the process of operation,the BIS were maintained in 40⁴9 in group D and 50⁵9 in group L.TCI protocol combined with sevoflurane adjusted the BIS value in target range from skin incision to the end of the operation.Meanwhile,the BIS values were recorded every 5 minutes,and the average value was calculated as grouping basis.The mean artery pressure?MAP?,heart rate?HR?and stroke volume variation?SVV?were recorded at start of anesthesia induction?T₀?,tracheal intubation?T1?,skin incision?T₂?,1h after skin incision?T₃?,2h after skin incision?T₄?,the end of operation?T₅?,5 minutes after extubation?T₆?.Blood samples were obtained from central vein at T₀,T₄,and T₆ and enzyme-linked immunosorbent assay was used to detect concentrations of serum interleukin-6 and tumour necrosis factor-?.We recorded the level of BIS from beginning of anesthesia induction to 5 minutes after extubation,the dosage of propofol and remifentanil,anesthesia duration,operation time,recovery time of respiratory,time of eye opening,extubation time,Steward score,intraoperative awareness,the fluid volume,urine output,blood loss.3 Excel was used to establish a database;SPSS17.0 statistical analysis software was used for statistical analysis;Measurement data was used by mean±standard deviation?sx±?.Comparisions between two groups were made by two independent samples t-test.Repeated measures analysis of variance was used to compare the differences between different time points in the group.Comparisions of enumeration data used chi-squared test.Difference was considered statistically significant at P<0.05.Results 1 The general situation of the patients such as age,gender,height,weight and ASA had no significant differences?P>0.05?.2 The BIS values were similar at start of anesthesia induction and 5 minutes after extubation?P>0.05?while the BIS values had significant differences at skin incision?T₂?,1h after skin incision?T₃?,2h after skin incision?T₄?,the end of operation?T₅?between two groups?P<0.05?.3 The two groups of patients with MAP,HR,CVP,SVV were relatively stable during the operation.In comparision with the group D,there were no significant differences in MAP at T₀?T1?T₅?T₆;The MAP in group L was higher than group D at T₂?T₃ and T₄?P<0.05?.There were no significant differences between two groups in CVP at T1?T₄ and T₅;the CVP in group L was higher than group D at T₂ and T₃?P<0.05?.There were no significant differences in SVV,fluid volume,urine output,blood loss?P>0.05?.4 In comparision with the group D,there were no significant differences in concentrations of serum TNF-? and IL-6 at T₀ and T₄,but concentrations of serum TNF-? and IL-6 in group L at T₆ were significantly lower than group D?P<0.05?.5 There were no significant differences in the dosage of remifentanil,anesthesia duration and operation time?P>0.05?.The dosage of propofol of group L was significantly lower than that in group D?P<0.05?.Postoperative recovery comparison of the two groups,recovery time of respiratory,time of eye opening and extubation time in group L were significantly shorter than group D?P<0.05?.Steward scores in group L were significantly higher than group D?P<0.05?.No intraoperative awareness occurred to all patients during operation.Conclusions 1 Among elderly patients with gastrointestinal tumor surgery under general anesthesia,the values of inflammatory cytokines of BIS between 50⁵9 were lower than BIS between 40⁵9,reducing the inflammatory reaction in the elderly patients.During the operation,the hemodynamics of two groups were stable,so lighter anesthesia can meet the requirements of the operation and do not accelerate the inflammatory reaction.2Among the elderly patients with gastrointestinal surgery,hemodynamics of two groups during anesthesia recovery period were stable and no intraoperative awareness occurred.On the other hand,the level of BIS between 50⁵9 during the operation reduces propofol consumption and shortens the consciousness recovery time in elderly patients.