Objectives: Bispectral index (BIS) can reflect the depth of propofol sedation. This study aims to compare the anesthetic satisfaction, anesthetic dose, and hemodynamic changes between closed-loop target controlled infusion (CLTCI) and open-loop target controlled infusion (OLTCI) during abdominal surgery.
Methods: From December 2016 to December 2018, 70 patients undergoing abdominal surgery under general anesthesia were selected in Beijing Hospital, including 51 males and 19 females, at the age from 49 to 65 years old. They were classified as grade I-II by the American Society of anesthesiologists (ASA) and were randomly divided into the CLTCI group and the OLTCI group (n=35). The CLTCI group received propofol CLTCI, and the target BIS value was set between 45 to 55; in the OLTCI group, the plasma target concentration was adjusted to maintain the BIS value between 40 to 60. Both groups were given remifentanil by target controlled infusion, and the plasma target concentration was 6.0 ng/mL. The percentages of adequate anesthesia time, deep anesthesia time, and light anesthesia time were calculated. The total induction dose of propofol, continuous infusion dose of propofol, predicted target propofol concentration of effect chamber, and continuous infusion dose of remifentanil were calculated. The times of automatic adjustment of propofol concentration in closed-loop system and manual adjustment of propofol concentration in the OLTCI group were recorded. Hemodynamic indexes were recorded, and the percentage of target mean arterial pressure (MAP) maintenance time and target heart rate (HR) maintenance time were calculated. Anesthesia time, operation time, recovery time, and extubation time were compared between the 2 groups.
Results: In the induction stage, the percentage of adequate anesthesia time in the CLTCI group was higher than that in the OLTCI group, and the percentage of deep anesthesia time in the CLTCI group was significantly lower than that in the OLTCI group (both P<0.05). In the maintenance stage, the percentage of light anesthesia time in the CLTCI group was significantly lower than that in the OLTCI group (P<0.05). The times of propofol adjustment in the CLTCI group was significantly more than that in the OLTCI group (P<0.001). The total induction dose of propofol in the CLTCI group was less than that in the OLTCI group (P<0.05), but there were no significant differences in the continuous infusion dose of propofol, predicted target concentration of propofol, continuous infusion dose of remifentanil between the 2 groups (all P>0.05). There were no significant differences in the percentages of target MAP maintenance time and target HR maintenance time between the 2 groups (both P>0.05). There was no intraoperative awareness in both groups, and there were no significant differences in operation time and anesthesia time between the 2 groups (both P>0.05).
Conclusions: Compared with propofol OLTCI, anesthesia with propofol CLTCI under BIS guidance can maintain a more appropriate depth of anesthesia sedation and more stable hemodynamics.
目的: 脑电双频指数(bispectral index，BIS)值可较好地反映异丙酚镇静深度。本研究比较腹部手术时采用异丙酚闭环靶控输注(closed-loop target controlled infusion，CLTCI)和开环靶控输注(open-loop target controlled infusion，OLTCI)进行麻醉时麻醉满意程度、麻醉药使用剂量和血流动力学的变化。方法: 选择2016年12月至2018年12月于北京医院择期行全身麻醉下腹部手术患者70例，其中男51例，女19例，年龄49~65岁，美国麻醉医师协会(American Society of Anesthesiologists，ASA)分级I~II级。采用随机信封法，将其分为CLTCI组和OLTCI组(n=35)。CLTCI组行CLTCI，设定目标BIS值为45~55；OLTCI组根据BIS值调节血浆靶浓度，维持BIS值40~60；两组均靶控输注瑞芬太尼，血浆靶浓度为6.0 ng/mL。分别计算麻醉满意时间、麻醉过深时间、麻醉过浅时间与麻醉时间的百分比，异丙酚的诱导总量、持续输注剂量、预计效应室靶浓度，瑞芬太尼持续输注剂量；记录CLTCI组异丙酚自动调整次数和OLTCI组手动调整异丙酚浓度的次数；记录血液动力学指标；分别计算目标平均动脉压(MAP)维持时间、目标心率(HR)维持时间与手术时间的百分比；比较2组患者麻醉时间、手术时间、苏醒时间、拔管时间等指标。结果: 诱导阶段CLTCI组麻醉满意时间与麻醉时间的百分比显著高于OLTCI组，麻醉过深时间与麻醉时间百分比显著低于OLTCI组(均P<0.05)；维持阶段CLTCI组麻醉过浅时间与麻醉时间百分比显著低于OLTCI组(P<0.05)。CLTCI组的闭环系统异丙酚自动调整次数显著多于OLTCI组的手动调整次数(P<0.001)。CLTCI组异丙酚的诱导总量少于OLTCI组(P<0.05)，但2组异丙酚的持续输注剂量、预计效应室靶浓度，瑞芬太尼持续输注剂量差异无统计学意义(均P>0.05)。2组目标MAP维持时间和目标HR维持时间与手术时间百分比差异无统计学意义(均P>0.05)。2组均未出现术中知晓，2组手术时间、麻醉时间等差异均无统计学意义(均P>0.05)。结论: 与BIS指导下异丙酚OLTCI麻醉比较，BIS指导下异丙酚CLTCI麻醉能维持更合适的麻醉镇静深度和更稳定的血流动力学。.
Keywords: bispectral index; closed-loop target controlled infusion; open-loop target controlled infusion; propofol; remifentanil.