With propofol
Group 1:
After placing the catheter, measure BP, heart rate, and evaluate the PRST score every 5 minutes to assess the level of anesthesia. If the PRST score is ≤ 2 and the hemodynamics are stable, there is no need to adjust the anesthesia level. If the anesthesia is too deep or shallow, and there are signs of consciousness during surgery (PRST score ≥ 3), the anesthesia level needs to be adjusted. If consciousness or shallow anesthesia is increased, increase it; if the anesthesia is too deep, decrease it. Each time, adjust the target concentration by 0.2 µg/ml. The concentration can be actively increased before surgery with strong intervention, and vice versa, decrease the concentration when the stimulation has decreased. For example, increase the anesthesia level before cutting the upper pole of the stomach. If the anesthesia is shallow, it can easily cause hiccups due to diaphragm stimulation. Or reduce the anesthesia level before closing the abdominal wall fascia. After 5 minutes of maintaining at the new target concentration, if the desired effect is still not achieved, continue to adjust as above until the requirement is achieved.
Group 2:
Also based on the level of anesthesia, PRST score is the same as group 1 to assess and adjust the level of anesthesia. Immediately after induction and intubation, switch to maintenance infusion at a dose of 6 mg/kg/h, then adjust the propofol infusion rate from 4-12 mg/kg/h.
[98] according to the patient's clinical response and the progress of surgery.
With combination drugs
- Fentanyl: dose 1.0 to 2.0 g/kg, according to the patient's clinical progress, or repeat every 20-30 minutes.
- Esmeron: adjust based on the index on the TOF-GUARD monitor, repeat injection of 10-15mg each time, to maintain less than 2 responses to train 4 stimulation.
minute.
Escape from anesthesia:
- Stop fentanyl and esmeron supplementation about 20 minutes before the end of surgery.
- Stop propofol infusion when skin closure begins.
- Muscle relaxation when the following conditions are met: TOF has ≥ 2 responses and recovery
Recovery at T1 is 25%. Use neostigmine at a dose of 40 - 50 µg/kg, combined with atropine 15µg/kg [10].
- Extubate when MOAAS sedation score ≥ 4, following orders correctly, breathing 12 - 25 times per minute, SpO 2 ≥ 95% with FiO 2 ≤ 40%, cough and swallow reflex, TOF index ≥ 0.9 (measured at the adductor pollicis muscle).
- Monitor patient every 5 minutes until reaching at least 10/14 points on the modified Aldrete scale to transfer to treatment room.
Maintain
PRST ≤ 2
Hemodynamic stability
Obtain
Are not
Increase target ND by 0.2
μg/ml every 5 minutes
Fake
μg/m
Assessment of anesthesia, PRST Blood pressure
Circuit frequency
Group 1
Propofol target: 4 μg/ml.
When eyelid reflex is lost: esmeron 0.6 mg/kg.
Set NKQ when MOAAS = 0. TOF ≤ 1
m NĐ target 0.2 l every 5 min | PRST ≥ 3 HA > Base HA + 15 M > M base + 15 | |
Too deep HA < baseline HA - 15 M < M base - 15 | ||
Maybe you are interested!
-
Comparison of the effects of two methods of complete intravenous anesthesia with Propofol with and without target concentration control - 2 -
Economic group model - operations of Vietnam Oil and Gas Group in the period 2006 - 2008 and development trends - 1 -
Developing cultural tourism from the potential of ethnic minorities in Ninh Thuan province, the case of the Raglai ethnic group in Bac Ai district - 17 -
Deviant Behavior of PCT Group in High School Students (%, N=448) -
Applying MIKE 11 model to determine minimum flow on the main stream of Vu Gia - Thu Bon river and proposing maintenance solutions - 13
Figure 2.1. Anesthesia maintenance process of group 1
Maintain
PRST ≤ 2
Hemodynamic stability
Obtain
Are not
Increase transmission speed
Reduce t
PRST Blood Pressure Assessment
Circuit frequency
Group 2
Propofol infusion 600 ml/h
When eyelid reflex is lost: esmeron 0.6 mg/kg.
Set NKQ when MOAAS = 0, TOF ≤ 1 response
transmission screw | PRST ≥ 3 HA > Base HA + 15 M > M base + 15 | |
Too deep HA < baseline HA - 15 M < M base - 15 | ||
Figure 2.2 . Anesthesia maintenance process of group 2
2.2.7. Ethics in research
The research process complies with the regulations in the Regulations on the operation of the Ethics Council in biomedical research issued together with Decision No. 5129/2002/QD - YT dated December 19, 2002 of the Minister of Health.
The main ethical aspects related to the rights of research subjects are as follows:
Benefits and risks to research subjects
In this study, patients who meet the selection criteria will undergo complete intravenous anesthesia with propofol with or without target concentration control, combined with muscle relaxants, analgesics, and endotracheal intubation and artificial ventilation. Propofol is an intravenous anesthetic with many advantages and has been widely used at home and abroad. Target concentration control anesthesia with propofol is increasingly widely applied in anesthesia practice due to its effectiveness and safety.
Commitment to voluntarily participate in research:
Patients will only be admitted to the study if they have signed the consent form. Depending on each specific case, the commitment will be made by the patient or the patient's family. Patients selected according to the criteria of the research subject will be informed about the research objectives, the benefits and risks of participating in the research, the rights and responsibilities of the research patient as well as the responsibilities of the researcher. When the patient or the patient's family understands the above content and signs the voluntary commitment, they will be admitted to the study. The research patient or their family has the right to refuse to participate or withdraw from the study without being discriminated against.
Information security
The personal information of patients collected from the research process is kept confidential and is only used for this research. The names and personal information of patients are not published in the research results published in scientific journals, scientific conference reports...
2.3. DATA PROCESSING
Research data results were processed on computer using SPSS 16.0 program.
The results of quantitative variables are presented in the form of± SD, (mean ±
standard deviation) and Min – Max (maximum - minimum).
Use t-test to test the difference between two groups with quantitative variables.
Use paired t-test to compare the mean difference of quantitative variables at two different time points of a group.
Use a one sample t-test to compare a mean with a given sample value.
Use the χ 2 (chi-square) test to test the relationship between qualitative variables.
The threshold for statistical significance was chosen with 95% confidence, the difference was statistically significant when p < 0.05.
Chapter 3
RESEARCH RESULTS
Study of complete intravenous anesthesia with propofol on 130 patients, including 65 patients in group 1 (target concentration controlled) and 65 patients in group 2 (no target concentration controlled), the results obtained are as follows:
3.1. PATIENT AND SURGICAL CHARACTERISTICS
3.1.1. Patient characteristics
Table 3.1. Age, height, weight, BMI
Group 1 (n= 65) | Group 2 (n= 65) | p | ||
Age (years) | ̅± SD | 53.03 ± 10.10 | 52.05 ± 10.18 | > 0.05 |
Min – Max | 20 – 65 | 25 - 65 | ||
Height (cm) | ̅ ± SD | 161.37 ± 6.65 | 162.25 ± 6.17 | > 0.05 |
Min – Max | 149 – 176 | 148 - 176 | ||
Weight (kg) | ̅± SD | 51.46 ± 5.96 | 51.75 ± 6.38 | > 0.05 |
Min – Max | 42 – 68 | 41 - 66 | ||
BMI (kg/m 2 ) | ̅ ± SD | 19.70 ± 1.32 | 19.59 ± 1.64 | > 0.05 |
Min – Max | 16.46 – 23.04 | 15.62 – 22.95 |
Comment:
- The mean values of age, height, weight and BMI between the two groups were not statistically significant, with p > 0.05. Thus, there was a similarity in the general characteristics of the two groups of patients in the study.
Table 3.2. Gender
Gender
Group 1 (n = 65) | Group 2 (n = 65) | p | |
Male | 36 (55.4%) | 37 (56.9%) | > 0.05 |
Female | 29 (44.6%) | 28 (43.1%) |
Comment:
- The ratio of male and female between the two study groups was not statistically significant, with p > 0.05. However, in each group, the ratio of male patients was higher than female.
3.1.2. Surgical characteristics
Table 3.3. Type of surgery
Type of surgery
Group 1 (n = 65) | Group 2 (n = 65) | p | |
Gastric surgery | 24 (36.9%) | 22 (33.9%) | > 0.05 |
Hepatobiliary surgery | 15 (23.1%) | 19 (29.2%) | |
Colon surgery | 18 (27.7%) | 19 (29.2%) | |
Pancreatic surgery | 8 (12.3%) | 5 (7.7 %) |
Comment:
- The rates of abdominal surgeries in the two groups were not statistically significant, with p > 0.05. In this study, gastric surgery had the highest rate in both groups, followed by colon and hepatobiliary surgeries.