ABBREVIATIONS AND SYMBOLS IN THE THESIS
Anesthesiologists)
ASA (American Society of: | American Society of Anesthesiologists | |
BMI (Body Mass Index) | : | Body mass index |
BN | : | Patient |
Ce (Effect-site Concentration) | : | Drug concentration at the site of action |
Clearance | : | Clearance coefficient |
Cp (Plasma concentration) | : | Plasma drug concentration |
CSHT (Context Sensitive Half Time) | : | Conditionally sensitive half-life situation |
ESDT (Effect-site Decrement Time) | : | Time to effect decline at target |
GABA | : | gamma-aminobutyric acid |
HA | : | Blood pressure |
HATB | : | Average blood pressure |
IPPV (Intermittent Positive Pressure Ventilation) | : | Positive pressure controlled ventilation intermittent |
glue | : | Distribution coefficient |
LBM (Lean Body Mass) | : | Body mass index |
LOC (Loss of consciousness) | : | Loss of consciousness |
MCI (Manually Controlled Infusion) | : | Manual transmission |
MOAAS (Modified Observer's Assessment of Alertness Sedation Scale) | : | Modified Observational Assessment of Alertness and Sedation Scale |
NKQ | : | Endotracheal |
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OAA/S (Observer's Assessment of Alertness Sedation Scale) | : | Observational assessment of alertness and sedation |
p (Probability) | : | Probability |
PaCO 2 (Arterial partial pressure of carbon dioxide) | : | Partial pressure of CO 2 in blood artery |
PCA (Patient controlled analgesia) | : | Patient-controlled analgesia |
PEtCO 2 (Pressure End - tidal of carbon dioxide) | : | End-expiratory CO 2 pressure |
PRIS (Propofol infusion syndrome) | : | Propofol infusion syndrome |
SD (Standard deviation) | : | Standard deviation |
SpO 2 (Saturation of peripheral oxygen) | : | Peripheral blood oxygen saturation |
TCI (Target Controlled Infusion) | : | Target concentration control |
TIVA (Total Intravenous Anaesthesia) | : | Complete intravenous anesthesia |
TOF (Train of four) | : | Four response chain |
TTPE (Time to peak effect) | : | Peak action time |
̅(Mean) | : | Average value |
χ 2 | : | When squared |
LIST OF TABLES
Table 1.1. Pharmacokinetic parameters in Marsh's model [105] 27
Table 3.1. Age, height, weight, BMI 59
Table 3.2. Gender 60
Table 3.3. Type of surgery 60
Table 3.4. Surgery time and anesthesia time 61
Table 3.5. Combination drugs, amount of intravenous fluids during surgery 61
Table 3.6. Muscle relaxants 62
Table 3.7. Time indicators during the induction phase 63
Table 3.8. Time indicators in the recovery phase 64
Table 3.9. Wakefulness time and estimated wakefulness time on the machine for group 1 65
Table 3.10. Propofol consumption 66
Table 3.11. PRST scores at some points 67
Table 3.12. Signs of consciousness during surgery (when PRST ≥ 3) 68
Table 3.13. Number of times anesthesia intensity had to be adjusted during surgery 68
Table 3.14. Number of times anesthesia intensity had to be adjusted during surgery 69
Table 3.15. Pain level at the time of NKQ removal 70
Table 3.16. Undesirable effects 70
Table 3.17. Changes in heart rate during induction of anesthesia 71
Table 3.18. Percentage of patients with bradycardia during induction of anesthesia 72
Table 3.19. Heart rate during anesthesia maintenance phase 72
Table 3.20. Heart rate during the recovery period 73
Table 3.21. Changes in BP during induction of anesthesia 74
Table 3.22. Number of patients with reduced BP at induction of anesthesia 75
Table 3.23. HATB during anesthesia maintenance phase 76
Table 3.24. HATB during the recovery period 77
Table 3.25. Maximum change in HATB 77
Table 3.26. Respiratory effects 79
Table 3.27. Propofol concentration at some time points of group 1 80
Table 3.28. Ce concentration to maintain anesthesia 81
LIST OF CHARTS
Figure 3.1. Time indicators during the induction phase 63
Figure 3.2. Time indicators in the recovery phase 64
Figure 3.3. PRST scores at some points in time 67
Figure 3.4. Percentage of patients with reduced BP at induction of anesthesia 75
Chart 3.5. Rate of HATB reduction levels 78
Chart 3.6. HATB at some points in time 78
Figure 3.7. Pulse frequency at some points in time 79
Figure 3.8. Propofol concentration at some time points of group 1 80
LIST OF FIGURES
Figure 1.1. Plasma and target propofol concentrations [105] 8
Figure 1.2: Three-compartment pharmacokinetic model 10
Figure 1.3: Situation-sensitive half-life of some drugs 12
Figure 1.4: Chemical formula of propofol 24
LIST OF PHOTOS
Photo 2.1: TCI-I system. 47
Photo 2.2. Terumo TE – 331 47 electric syringe
Photo 2.3: Fabius GS 48 anesthesia machine
Photo 2.4: TOF- GUARD 49 muscle extensometer
Photo 2.5: Life scope I 49 monitor
LIST OF DIAGRAM
Figure 2.1. Anesthesia maintenance process of group 1 55
Figure 2.2. Anesthesia maintenance process of group 2 56
PROBLEM STATEMENT
Total intravenous anesthesia (TCI) is a method of general anesthesia that does not use gaseous anesthetics. This method has been proven to have many advantages, so anesthesiologists are tending to use TCI more in clinical practice [40], [111], [125], [134].
The intravenous anesthetic propofol (Diprivan) has been used since 1983 for induction and maintenance of anesthesia [53], [95]. Domestic and foreign studies have shown that the use of propofol allows easy control of anesthesia level, short latency period, good quality of awakening, low rate of nausea and vomiting after anesthesia, shortening hospital stay [10], [95], [105], [106]. In Vietnam, propofol has been used since the 1990s for sedation purposes during procedures or anesthesia on many different patient populations [2], [6], [8], [11], [12].
A deeper understanding of the pharmacokinetics of intravenous anesthetics combined with advances in information technology in cybernetics has led to the development of Target Controlled Infusion (TCI). The first commercial target-controlled infusion device was introduced in 1996. This system is capable of controlling the estimated drug concentration in the target organ, the plasma or the brain, where the drug exerts its clinical effect, through the control of an automated injection pump by a microprocessor based on a database of pharmacokinetic parameters of the drug. This technique has brought many advantages in the control of induction and maintenance of anesthesia for intravenous anesthetics compared to other conventional techniques.
[19], [69], [134]. Currently, in many places around the world, intravenous anesthesia with target-controlled propofol concentration has become routine [53], [95], [105].
In Vietnam, propofol is often used for intravenous anesthesia by injecting intermittent doses (bolus) or using continuous drip baskets or using continuous infusion pumps... depending on the equipment conditions of each medical facility [7], [10]. The selection and adjustment of drug dose, injection speed, and interval between injections depends entirely on the clinical experience of anesthesiologists, so the quality of anesthesia is not really stable and uniform. Recently, anesthesia with propofol using the new target concentration control technique has been introduced and initially applied in anesthesia practice in Vietnam. However, the number of patients in research reports on target concentration control anesthesia published in the country is still limited, so the evaluation and comparison of the effectiveness of this method with methods currently being conducted clinically in Vietnam is not complete [1], [2], [3], [4], [5].
Based on that reality, we conducted the topic "Comparison of the effects of two methods of complete intravenous anesthesia with propofol with and without target concentration control" with the following objectives:
1. Comparison of the efficacy of target-controlled propofol anesthesia with non-target-controlled propofol in patients undergoing planned abdominal surgery.
2. Comparison of hemodynamic and respiratory effects between target-controlled and non-target-controlled anesthesia
3. Determine the target concentration values of propofol during anesthesia in the target concentration-controlled anesthesia group.
1.1.INTERVANEOUS ANESTHESIA
1.1.1. Definition
Chapter 1
OVERVIEW
Intravenous anesthesia is the administration of anesthetic drugs into the patient's body intravenously, resulting in a clinically reversible state of anesthesia, including loss of consciousness, muscle relaxation, analgesia, and neuroendocrine stabilization [7].
Total intravenous anesthesia is a method that uses only intravenous anesthetics, not volatile anesthetics.
1.1.2. Advantages
Intravenous anesthesia has the following main advantages:
- Can control pre-sedation and help rapid induction of anesthesia
- Less pollution to the operating room environment
- The drug delivery route does not obstruct airway access
- Does not increase fluoride ion (F - )
- Safe with CO 2 absorbers
- Maintain vasoconstriction reflex in case of hypoxemia
- Reduce the rate of malignant hyperthermia
- Less nausea and vomiting after surgery
- Good quality of awakening and ability to continue to maintain sedation, pain relief after surgery… [125].
1.1.3. Forms of intravenous anesthesia
1.1.3.1.Pure intravenous anesthesia
Pure intravenous anesthesia is a form of anesthesia that uses only one intravenous anesthetic agent. It is not recommended for long or major surgeries, because it is not only very wasteful of drugs
but also dangerous for the patient. Nowadays, pure intravenous anesthesia is only used for patients who need outpatient anesthesia to perform procedures such as gastrointestinal endoscopy, minor surgery in a short time that does not require much pain relief and muscle relaxation (joint adjustment, abscess lance, dressing change in burn treatment...)
1.1.3.2.Dissociative anesthesia
This is a simple intravenous anesthesia method with ketamine (the only intravenous anesthetic that can be used intramuscularly). Ketamine is well indicated for patients with low blood pressure. The drug has a superficial sedative effect and superficial analgesic effect thanks to its combined effect in three places: the fifth area of the dorsal horn of the spinal cord, the brain stem and the thalamocortical system... The sedative effect is recorded in the recovery phase (hallucinations, agitation...). It is the result of dissociation due to decreased activity in the cerebral cortex, but increased activity in the limbic system.
1.1.3.3.Balanced anesthesia
Balanced anesthesia is the most common general anesthesia technique, which combines drugs to ensure four factors: loss of consciousness, analgesia, autonomic protection, and muscle relaxation [7].
1.2. TARGET CONTROLLED ANESTHESIA
Regardless of the form of intravenous anesthesia, the problem that anesthetists are always concerned about is how to maintain a stable level of anesthesia. In 1968, Kruger - Thiemer proposed the BET (Bolus - Elimination - Transfer) method to maintain stable blood concentrations of intravenous anesthetics. This method includes the following steps: a bolus dose fills the central compartment, then continuously infuses at an exponentially decreasing rate to compensate for the amount of drug metabolized and eliminated in the peripheral compartments [113].