The Value Of Anesthesia Depth For Anesthesia Monitoring Of Supratentorial Tumor Resection

Objective:To observe the effect of BIS monitoring on the quality of intraoperative and postoperative recovery in patients undergoing supratentorial tumor resection,and explore the perioperative brain protection effect of different anesthesia depths and provide a basis for clinically appropriate anesthesia depth.Methods:A total of 105 patients with supratentorial tumor resection undergoing elective general anesthesia between June 2017 to June 2018 in Shanxi provincial people's Hospital were selected as object of study.According to the random number table method,the 105 patients were divided into experimental groups:H group?BIS50-59?,L group?BIS40-49?and control group:Group C.The three groups were treated with total intravenous anesthesia.Blood pressure?Bp?,electrocardiogram?ECG?,blood oxygen saturation?SpO2?,end-tidal carbon dioxide partial pressure?petCO2?and bispectral index?BIS?were routinely monitored after entering the operating room.Conventional mechanical ventilation was given after tracheal intubation,and respiratory parameters were adjusted:VT6-8ml/kg,IE1/2,FiO280%.Maintain petCO2 between 35-45mmHg by adjusting respiratory rate during surgery.In the experimental group,the infusion rate of propofol and remifentanil was adjusted according to the BIS value,and the homeopathic atracurium and sufentanil were added to maintain the stability of the anesthesia and meet the surgical needs,so that the BIS value of the H group was maintained in the range of 50 to 59.,the BIS value of the L group is maintained in the range of 40 to 49.The Group C BIS monitoring screen is completely blocked,and the anesthesiologist adjusts the depth of anesthesia based on personal experience.?1?BIS?Bispectral index scale?,HR?heart rate?,MAp?mean arterial pressure?were recorded at different time points including before induction?T0?,10 minutes after tracheal intubation?T1?,incision?T2?,drilling?T3?,30 minutes after incision of the dura?T4?,suture?T5?,10 min after extubation?T6?;as well as Glu value at different time points including before the patient was induced?T0?,drilling?T3?,and 10 min after extubation?T6?.?2?Record the aIntraoperative anesthetic dose,intraoperative adverse reactions and quality of anesthesia recovery in three groups;?3?Cognitive function scores?MMSE scores?were recorded before?M0?and 1^st?M1?,3^rd?M2?and 7^th?M3?days after surgery.Results:Five patients in group H,group L and group C were excluded,and 30 patients in each group were evaluated.There were no significant difference in preoperative and intraoperative data in the three groups?p>0.05?.Comparing the intraoperative BIS values in the three groups:Compared with the experimental group,the BIS value of the C group was significantly increased at T2?p<0.05?,and decreased significantly at T3 and T4?p<0.05?;It shows that BIS monitoring during the operation,the depth of anesthesia is maintained more stable.Comparing the HR in the three groups:Compared with T0,HR in group H increased at T4-T6?p<0.05?;HR in group L decreased at T1?p<0.05?,and there were no statistically significant difference between the remaining time points and T0.;HR in group C increased at T2 and T6?p<0.05?,decreased at T3 and T4?p<0.05?.It showed that the hemodynamic fluctuations in group C were significantly higher than those in the experimental group.Compared with BIS maintained at 50-59,intraoperative BIS maintained at 40-49 can maintain a more stable hemodynamics.The blood glucose levels of the three groups were compared:Compared with T0,the T3 and T6 were increased in the three groups?p<0.05?.There were no significant difference in blood glucose between the H group and the C group at each time point?p>0.05?;The blood glucose levels of the patients in the group L were lower than those of the other two groups at T3 and T6?p<0.05?.It indicates that the intraoperative BIS is maintained at 40-49,which can better control the level of stress response and reduce the extent of perioperative blood glucose rise.Comparing intraoperative anesthetic doses in the three groups:there were no significant difference in the dose of sufentanil in the three groups?p>0.05?.Compared with the experimental group,the amount of propofol and remifentanil in the group C increased?p<0.05?.Compared with the H group,the amount of propofol in the L group increased?p<0.05?,and the amount of homeopathic atracurium decreased?p<0.05?.The incidence of adverse reactions in the three groups of patients:the incidence of Intraoperative hypertension in the H group was higher than the other two groups?p<0.05?;the incidence of intraoperative hypotension in the C group was higher than the other two groups?p<0.05?.Compared with the experimental group,the incidence of intraoperative body motion was higher in group C?p<0.05?.Comparing the quality of anesthesia recovery period in three groups of patients:There were no significant difference in postoperative VAS scores between the three groups?p>0.05?.Compared with the experimental group,postoperative respiratory recovery,blinking and extubation time increased in group C?p<0.05?,postoperative agitation score increased?p<0.05?.Compared with H group,postoperative agitation score decreased in group L?p<0.05?.Compared with the experimental group,the incidence of intraoperative awareness was higher in group C?p<0.05?.Comparing the MMSE scores of the three groups:the MMSE scores of the three groups were lower than those before the operation?p<0.05?;there were no significant difference between the H group and the C group at each time point?p>0.05?;The MMSE scores of the L group were increased compared with the other two groups on the 1st and 3rd day after operation?p<0.05?.There were no significant difference in the MMSE scores between the three groups on the 7th day after surgery.Which indicates that the intraoperative BIS maintained at 40-49 is beneficial to reduce the early postoperative cognitive function damage.Conclusion:In the surgical resection of supratentorial tumors in neurosurgery,monitoring the depth of anesthesia with BIS can reduce perioperative hemodynamic fluctuations,effectively reduce the amount of intraoperative anesthetic drugs,and reduce the incidence rate of adverse reactions such as intraoperative body motion and intraoperative awareness so as to improve the quality of perioperative anesthesia,and shorten the time of anesthesia recovery,reduce the degree of dysphoria during the recovery period so as to improve the quality of anesthesia recovery period.Compared with BIS maintained at 50-59,intraoperative BIS values maintained at 40-49 are more conducive to control the level of intraoperative stress response,maintain relatively stable hemodynamics,and reduce postoperative early cognitive dysfunction,which is conducive to perioperative brain protection.