| Objectives:Under the ConView anesthesia depth monitor,the effects of propofol anesthesia and sevoflurane anesthesia on eeg spectrum in laparoscopic cholecystectomy will be compared,and the effects and adverse reactions of the two anesthesia methods will be compared.Meanwhile,by comparing with Bispectral index(BIS),the application effect of Anesthesia index(Ai)in ConView Anesthesia depth monitor in Anesthesia depth monitoring in general Anesthesia will be evaluatedMethods:The patients who met the inclusion criteria and planned to undergo laparoscopic cholecystectomy under general anesthesia were randomly divided into two groups,and the general information of the patients was recorded:gender,age,BMI,complications,smoking history,drinking history,and allergy hi story.BIS monitor and ConView monitor were used for monitoring and eeg recording of patients during anesthesia.Group A was induced by sevoflurane tidal volume method,while group B was induced by Agilia TCI pump Schnider mode target controlled infusion of propofol with an initial Ce of 3.0 g/mL,followed by A gradient increase of 0.3 g/mL until the patient’s consciousness disappeared.Minto mode target-controlled infusion of REmifentanil Ce 4 ng/mL was used in both groups.After the patients’ consciousness and eyelash reflex disappeared,the mandibular assisted breathing was lifted up,and rocuronium 0.6mg/kg was injected intravenically.After the BIS value dropped to 55,tracheal intubation was performed after muscle relaxation.After successful intubation,respiratory was controlled by machine.Tidal volume was set at 6mL/kg～8mL/kg,PEEP at 5cmH2O,and respiratory frequency was adjusted to maintain airway pressure less than 25cmH2O and Pet CO235mmHg～45mmHg.The Cp 4ng/mL of remifentanil was maintained unchanged in the two groups;inhalation of sevofluranewas continued in group A,and propofol was maintained by target controlled infusion in group B.Inhalation concentration of sevoflurane and infusion speed of propofol were adjusted according to BIS value and hemodynamics.Record before anesthesia induction(T1),loss of consciousness(T2),endotracheal intubation(T3)immediately before and immediately after endotracheal intubation(T4),cut skin when(T5),waking him only when(T6),tube drawing(T7)when the patient’s heart rate(HR),mean arterial pressure(MAP),eeg double-frequency index(BIS),anesthesia awareness index(Ai),the index of electromyography(EMG),explosion suppression ratio(BSR),record the MAC values given for each time point of group A,group B to record the all time points of room effect of propofol concentration(Ce mu g/mL).Patients were graded on The OAA/S(The Observer’s Assessment of Alertness/Sedation Scale)at time points T1,T2 and T3,and patients were graded on The quality of wakefulness by Steward recovery Scale at time points T6 and T7.The time from induction to consciousness loss was recorded as the induction time(S),the time of awakening(S)in group A was the time from discontinuation of sevoflurane to increasing oxygen flow to flushing the pipeline to the waking and opening eyes of the patients,and the time from discontinuation of propofol to the waking and opening eyes of the patients in group B was recorded as the time from discontinuation of propofol to the waking and opening eyes of the patients.Patients were observed for restlessness in the wake period,nausea and vomiting within 24 hours after surgery during the transfer from the operating room to the resuscitation room and back to the ward.Patients were followed up for intraoperative awareness on the first and fourth days after surgery.Electroencephalogram(EEG)was collected during anesthesia and the spectrum was obtained after data reprocessing.The measurement data of normal distribution were expressed as mean ±standard deviation(x±s),and independent sample T test was used.Enumeration data were expressed in frequency(%)and chi-square test was used.Bland-altman plot was used to analyze the consistency between BIS and Ai.Results:1.There was no statistically significant difference in general conditions between the two groups(P>0.05);2.The difference of induction time and wake time between the two groups was statistically significant(P<0.05).Two groups of patients with induction period OAA/S score,Steward to score,emergence agitation and postoperative nausea and vomiting,intraoperative awareness to compare differences had no statistical significance(P>0.05).3.The two groups of patients with operation time,rui fentanyl dosage,the dosage of ephedrine comparative differences had no statistical significance(P>0.05)4.Two groups of patients before anesthesia induction(T1)HR,MAP,comparative differences between groups had no statistical significance(P>0.05);When the consciousness disappeared between the two groups,HR(T2)and MAP decreased compared with T1,but there was no statistically significant difference between T2 and T1 in group A(P>0.05),and there were statistically significant differences between T2 and T1 in MAP and MAP in group A and B(P<0.05).HR and MAP of patients in both groups immediately after intubation(T4)and immediately before intubation(T3)were significantly increased,and the difference was statistically significant(P<0.05).5.In group A,MAC was 1.4±0.26 when consciousness disappeared(T2)and 0.14±0.05 when consciousness recovered(T6).Ce value was 3.41±0.85μg/mL when consciousness disappeared and 1.01±0.20ug/ml when consciousness recovered(T6).Among the 6.7 time points.the highest point was 7.7%outside 95%LoA.Clinically,the difference was within an acceptable range,proving that Ai and BIS had good consistency.7.The spectrum of patients in both groups during the maintenance phase of anesthesia was characterized by wave(7Hz～12Hz)and(<4Hz)slow wave oscillations.In addition,the wave(4Hz一 7Hz)frequency band was more obvious in group A than group B.Conclusions:1.There is a good consistency between Ai and BIS.Con View anesthesia depth monitor can be used for the evaluation of anesthesia depth in general anesthesia.2.During the maintenance period,the eeg of the two groups was characterized by wave(<4Hz)and wave(7Hz-12Hz)oscillations.Compared with the propofol group,the sevoflurane group significantly increased in the wave(4Hz～7Hz)frequency band,which was the characteristic of sevoflurane.3.The induction of sevoflurane by tidal volume inhalation was faster than that by increasing concentration of propofol TCI,and the induction of sevoflurane through inhalation anesthesia was faster than that by intravenous anesthesia.4.Both anesthesia methods can provide good anesthetic effect for laparoscopic cholecystectomy,and there are few adverse reactions.There is no intraoperative awareness,restlessness in the recovery period,and low incidence of postoperative nausea and vomiting in both groups. |
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