The study of safety and saving efficacy on bispectral index-based closed-loop target controlled infusion propofol with bispectral index-target controlled infusion pump for gynecological laparoscopic surgery

Abstract

Objective To observe hemodynamic change and saving efficacy in patients undergone gynecological laparoscopic surgery under closed-loop control of target controlled infusion(TCI) propofol guided by BIS with BIS-TCI pump. To explore the guiding effect and reference value of BIS-TCI pump on accurate implementation of total intravenous anesthesia. Methods Forty patients who experienced gynecological laparoscopic surgery were enrolled in this study and divided into two groups randomly. The anesthesia was maintained with closed-loop control of propofol TCI guided by BIS with BIS-TCI pump in the closed-loop group. While the anesthesia was maintained with manually regulating plasma concentration 2-5 mg/L of propofol TCI guided by BIS with TCI pump in the opened-loop group. The target BIS value was 50±5. The plasma concentration 4 μg/L of remifentanil TCI was used for analgesia. BIS value, MAP, HR were recorded for each patient at the time point of pre-anesthesia, tracheal intubation, 1 min after tracheal intubation, 5 min after tracheal intubation, skin incision, 30 min after skin incision, skin suture, the end of surgery, consciousness recovery, extubation, 5 min after extubation. The consumption of propofol, the anesthesia recovery time, the score of numerical rating scale(NRS) and Ramsay were also recorded. Results The dosage of propofol during the anesthesia was decreased by 10% in the closed-loop group which compared with opened-loop group[(6.2±1.4) mg·kg-1·h-1 vs (6.9±1.0) mg·kg-1·h-1(P>0.05). BIS value, MAP, HR between the two groups had no significant differences at the each time point (P>0.05), but the hemodynamic change at the time point of skin incision was less in the closed-loop group compared with opened-loop group(P 0.05). Conclusions Compared with the opened-loop control of propofol TCI guided by BIS with TCI pump, the closed-loop control of propofol TCI guided by BIS with BIS-TCI pump could be safely applied in clinic, made the infusion of anesthetics more individually, and decreased the consumption of propofol. At the same time, closed-loop controlled infusion with BIS-TCI pump can also decrease the anesthesiologist's workload and make patients pass the peri anesthesia period smoothly and safely. Key words: Bispectral index; Target controlled infusion; Propofol; Laparoscopic surgerical procedures