(Close-Loop Muscle Relaxant Injection System,CLMRIS)

5 MMJC May 2012 Vol 14 No.5 21 Narcotrend Narcotrend (NT) (Close-Loop Muscle Relaxant Injection System CLMRIS) 352 ASA ~ 4 : (E )NT (N )CLMRIS (C )NT CLMRIS (NC ) 88 E ;N NT ;C CLMRIS ;NC NT CLMRIS (T 0 ) (T 1 ) (T 2 ) (T 3 ) (T 4 ) (T 5 ) (T 6 ) (T 7 ) (T 8 ) (T 9 ) (T 10 ) 11 (MAP) (HR) (RR) (SpO 2 ) NT (NTS) NT (NTI) TOF (T 2 ~T 1 ) 4 ;NC MAP HR (P<0.05);E T 8 ~T 10 RR SpO 2 (P>0.05) NC NTS NTI (P<0.05);C NC TOF T 3 ~T 8 (P<0.05)T 9 ~T 11 (P>0.05) NC E (P<0.05);C N NC (P>0.05)NC Copper Ramsay (P<0.05) 4 (P>0.05)NC NT Application of Narcotrend monitors combined with Close-Loop Muscle Relaxant Injection System in general anesthesia Liang Bin Zhang KangqinZheng Hengxinget al. Department of AnesthesiologyBaoji Central HospitalShaanxi 721008 Abstract Objective To research clinical efficacy and safety of Narcotrend monitors(nt) combined with Close-Loop Muscle Relaxant Injection System (CLMRIS) in general anesthesia. Methods 352 selected patients of general anesthesia ASA ~ were randomly divided into four groups: experience group (E groupn=88) NT group (N groupn=88) CLMRIS group (C groupn=88) and NT combined with CLMRIS group (NC groupn=88). The anesthesiologist determined the delivery of anesthesia based on clinical experience in E Group based on the guidance of anesthesia monitoring in N group based on CLMRIS guidance of muscle relaxants used in C group based on guidance of anesthesia and muscle relaxants used in NC group. Observed mean arterial pressure (MAP) heart rate (HR) respiratory rate (RR) pulse oxygen saturation (SpO 2 ) NT stage (NTS) NT index (NTI) muscle relaxants count train-of-four (TOF) value the total narcotic medication intubation time (T 2 ~T 1 ) analepsia time extubation timeintubation timerating and sedation score out of room rating and sedation score out of room at induced immediate intubationskin incision into the abdomen exploration the abdomen closed slit the skin recovery of consciousness tracheal tubes asideout the operating room respectively. Recorded adverse reaction. Results All patients' vital signs were stable during surgery. MAP HR changes of the NC group were more stable than that of others (P<0.05). RR and SpO 2 were the lowest point in E Group of the T 8 ~T 10 (P>0.05). NTS NTI of NC group and N group were nearer to anesthesia target than that of the other two groups (P<0.05). Muscle relaxant count TOF value in NC group and C Group were lower than that of the other two groups (P<0.05) in T 3 ~T 8 higher than that of the other two groups (P<0.05) in the T 9 ~T 11. The dose of drugs in induction period was no significant differences there were difference in the maintenance phase. In NC group intubation time was the longest recovery time and extubation time were the shortest Copper rating and Ramsay score were the most appropriate (P<0.05). There were no differences of awareness in four groups (P>0.05)no adeverse reactions in NC group :721008

22 5 MMJCMay 2012 Vol 14 No.5 (P<0.05). Conclusion NT combined with CLMRIS in general anesthesia is useful to improve the safety. It's controllable stable during induction analepsia complete achieving the best anesthetic effect by using less anesthetic agents and reducing the adverse effects of general anesthesia. Key words Narcotrend monitor(nt) Close-Loop Muscle Relaxant Injection System(CLMRIS) Total intravenous anesthesia (TIVA) ) CLMRIS: ( ) ( LMRIS- ) ( 5 ) ( TOF 6 ) 4 (train-of-fourtof)( 2Hz 20s) TOF Narcotrend(NT) E (Close-Loop Muscle Relaxant Injection System : (0.02mg kg -1 )+ CLMRIS) (2~4μg kg -1 )+ (0.3~0.4mg kg -1 )+ (0.5~1 mg kg -1 ) 1 1.1 2011 3 ~2011 10 ASA 352 (0.8~1.0mg kg -1 ) 8~10ml kg -1 12 / min 1 2 PetCO 2 30 ~ ~ 35mmHg : (4~12mg kg -1 h -1 ) 94~181min 43.8~86.2kg 4 : (E );NT (N );CLM- 0.02mg kg -1 RIS (C );NT CLMRIS (NC ); ; 88 4 ASA SpO : 2 1~2μg kg -1 ; (1mg 0.5mg) ; ; ; : >6ml/kg 5min 95% 1.2 N NT (Target Controlled InfusionTCI) :D1~E2(56~13)NTI 56 8~12h NT CLMRIS 0.02mg kg -1 ;NTI 13 1 E NT: C CLMRIS 3 NT : ( 20mg ( schiller) 20ml 0.1mg/kg) <5.0kΩ <3.0kΩ ( 1 0.1mg kg -1 h -1 3min NT T 0 ( 0.01mg kg -1 h -1 65mA

5 MMJC May 2012 Vol 14 No.5 23 200μs ) T 1 100% ; (3 ): 0 ; ; (2 ): 1 TOF 30%; ; (1 ): T 1 90% E NC NT CLMRIS Ramsay N C :1 ;2 ;3 1.3 :NT ;4 ;5 3min (T 0 ) (T 1 ) (T 2 ) ;6 2~4 (T 3 ) (T 4 ) (T 5 ) (T 6 ) (T 7 ) (T 8 ) (T 9 ) (mean arterial pressure MAP) (heart ratehr) (respiratory raterr) (Pulse oxygen saturation SpO 2 ); NT (NT stagents) NT (NT indexnti) (T 2 ~T 1 ) 5~6 (T 10 ) 11 1.4 SPSS 12.0 ± (x±s) Kruskal-Wallis H Nemenyi P <0.05 TOF ; 2 ( ) ( 2.1 4 ); NC MAP HR (P<0.05);E T 8 ~T 10 RR (P>0.05) : Copper T 0 ~T 1 E C T 8 ~T 10 MAP HR [1] (4 ): (P>0.05) 1 1 4 (x±sn=88) T 0 T 1 T 2 T 3 T 4 T 5 T 6 T 7 T 8 T 9 T 10 MAP(mmHg) E 86.3±12.7 85.7±12.5 90±18.6 99.3±13.4 104.4±12.2 88.3±14.8 98.4±13.3 98.1±16.6 c 106.8±17.2 c 113.6±15.6 c 103.7±13.5 c N 87.5±11.8 83.5±12.6 79.5±15.8 a 80.3±10.2 a 77.5±11.5 a 82.6±14.6 81.3±13.8 a 85.4±13.6 ab 88.9±11.0 ab 90.3±12.3 ab 86.4±10.6 ab C 83.6±12.3 80.6±10.8 80.2±9.3 a 88.4±12.8 a 85.4±9.5 a 88.1±10.7 84.2±11.2 a 96.2±10.6 c 98.4±12.6 c 105.6±13.5 c 102.8±9.9 c NC 85.8±9.5 82.5±11.5 75.8±10.2 a 78.5±10.6 a 75.2±8.5 a 80.8±9.9 a 78.5±10.9 a 81.5±9.5 ab 83.8±10.3 ab 86.6±10.3 ab 82.6±9.2 ab HR( /min) E 86.5±12.2 83.2±12.0 95.0±17.4 79.8±15.3 92.5±14.7 83.6±15.8 98.3±16.4 96.3±15.2 103.2±14.7 c 112.0±15.6 c 103.6±13.9 c N 88.8±13.5 80.1±9.8 81.3±10.3 a 83.2±9.6 79.3±13.2 a 82.3±10.7 80.2±12.7 a 85.5±12.0 ab 88.1±12.6 ab 91.2±12.2 ab 86.9±10.4 ab C 84.2±12.9 81.6±10.7 85.2±14.5 a 91.1±13.8 86.1±12.9 89.8±8.8 88.5±10.2 91.9±14.6 94.6±13.6 ac 98.2±13.8 ac 91.2±11.0 a NC 89.7±10.6 82.4±11.5 76.8±10.8 a 80.8±10.6 73.8±10.1 a 80.5±12.5 77.6±9.5 a 83.5±10.9 a 85.3±11.1 a 88.5±11.6 ab 83.6±9.8 ab RR( /min) E 20.1±3.5 20.0±3.2 0 0 0 0 0 0 15.4±3.9 16.3±3.1 17.2±3.6 N 20.5±2.6 19.2±2.9 0 0 0 0 0 0 18.8±3.5 a 19.6±2.5 a 20.1±3.1 a C 21.2±2.9 19.6±2.8 0 0 0 0 0 0 19.2±3.2 a 20.3±3.7 a 20.9±3.6 a NC 20.8±3.2 18.9±3.3 0 0 0 0 0 0 20.6±3.8 a 20.8±3.6 a 21.5±3.3 a SpO 2 (%) E 95.1±2.2 98.1±1.5 99.2±0.6 99.5±0.3 99.6±0.3 99.8±0.1 99.5±0.4 99.2±0.6 93.0±2.6 96.5±1.6 95.5±1.6 N 96.8±1.8 98.3±1.3 99.6±0.3 99.4±0.5 99.5±0.4 99.4±0.5 99.4±0.3 99.5±0.4 97.1±3.5 a 98.0±2.2 a 98.4±1.3 a C 96.5±1.9 98.0±1.8 99.5±0.4 99.8±0.2 99.3±0.5 99.6±0.4 99.3±0.5 99.3±0.6 97.6±1.8 a 98.2±1.6 a 98.6±1.2 a NC 95.3±2.1 98.5±1.5 99.4±0.5 99.6±0.3 99.2±0.6 99.8±0.2 99.5±0.3 99.6±0.5 98.3±1.5 a 98.6±1.8 a 98.8±1.5 a P <0.05; T 0 T 1 b P >0.05 c P <0.05

24 5 MMJCMay 2012 Vol 14 No.5 2.2 NTS NTI TOF T 3 ~T 6 (P<0.05) T 8 ~T 10 NC N NTS NTI (P<0.05) 2 (P<0.05);NC C TOF 2 NTS NTI TOF (%x±s n=88) T 0 T 1 T 2 T 3 T 4 T 5 T 6 T 7 T 8 T 9 T 10 NTS E 0(0) 0(0) 70(79.5) 74(84.1) 76(86.4) 68(77.3) 78(88.6) 75(85.2) 10(11.2) 7(8.0) c 5(5.87) c N 0(0) 0(0) 87(98.9) a 88(100) a 85(96.6) a 86(97.7) a 87(98.9) a 85(96.6) a 0(0) a 0(0) ab 0(0) ab C 0(0) 0(0) 74(84.1) 77(87.5) 80(90.9) 74(84.1) 79(89.8) 73(83.0) 8(9.1) 6(6.8) c 4(4.5) c NC 0(0) 0(0) 88(100) a 88(100) a 87(98.9) a 86(97.7) a 86(97.7) a 84(95.5) a 0(0) a 0(0) ab 0(0) ab NTI E 96.0±2.6 89.3±5.1 49.5±10.8 53.5±12.6 38.6±12.9 56.3±11.6 64.8±12.3 53.9±10.5 70.3±10.8 c 81.6±7.6 c 90.6±5.7 c N 95.8±2.5 88.9±6.8 38.2±8.3 a 42.4±9.2 a 43.8±10.5 45.8±9.3 a 43.5±8.3 a 40.3±9.6 a 86.8±8.9 a 92.6±3.6 a 96.7±3.0 ab C 96.3±2.4 90.5±4.3 48.8±11.6 50.3±10.7 40.7±9.8 53.6±10.2 58.9±10.6 50.4±10.9 73.6±10.2 c 80.1±8.9 c 91.3±6.6 c NC 96.1±2.8 89.4±5.8 40.5±9.9 a 43.8±8.5 a 39.9±10.2 45.8±8.8 a 42.4±9.8 a 43.6±9.3 a 88.5±9.4 a 95.6±2.8 ab 97.1±2.5 ab E 4±0 4±0 3.2±0.5 1.5±0.6 1.2±0.2 3.0±0.5 3.5±0.4 1.5±0.6 3.0±1.2 c 3.2±0.8 c 3.5±0.9 c N 4±0 4±0 3.0±0.3 0.8±0.2 1.0±0.6 2.7±0.6 2.0±0.6 2.3±0.8 3.2±0.9 c 3.3±0.6 c 3.5±0.6 c C 4±0 4±0 2.0±0.4 d 0.2±0.1 d 0.3±0.1 d 0.5±0.2 d 0.4±0.2 d 3.0±0.5 d 3.8±0.4 db 3.9±0.5 db 3.9±0.4 db NC 4±0 4±0 1.9±0.3 d 0.1±0.1 d 0.1±0.2 d 0.3±0.1 d 0.4±0.2 d 3.2±0.5 d 3.8±0.5 db 3.9±0.3 db 3.9±0.2 db TOF E 99±0.8 99±0.7 6±3.2 15±0.1 9±0.6 14±0.9 8±0.3 6±2.1 30±8.9 c 45±18.5 c 62±12.9 c N 99±1.0 99±0.9 0 1±0.5 0 3±1.0 1±0.2 13±4.2 38±16.9 c 60±15.9 c 70±9.3 c C 99±0.9 99±0.6 0 0 0 0 0 16±3.0 55±21.3 d 76±11.7 d 93±4.6 db NC 99±1.1 99±0.8 0 0 0 0 0 19±3.8 59±18.6 d 79±10.4 d 95±6.8 db : E C a P <0.05; E N d P <0.05; T 0 T 1 b P >0.05 c P<0.05 2.3 2.4 Copper NC Ramsay NC E (P<0.05);C N Copper Ramsay (P < NC (P>0.05) 3 3 4 (x±sn=88) 4 4 Copper Ramsay (mg) (mg) (mg) (mg) (mg) (x±sn=88) Copper Ramsay (min) (min) (min) E 2.0±0.6 70±28.5 2.2±0.5 0 6.5±2.1 N 2.1±0.5 68±21.4 2.3±0.8 0 6.8±2.5 E 173±22.6 12.3±4.5 19±7.8 3.0±0.68 3.7±0.51 C 1.8±0.8 72±23.9 2.1±0.6 0 6.6±2.8 N 221±28.8 a 6.8±3.2 ab 12±5.2 a 3.6±0.52 ab 2.3±0.65 ab NC 1.9±0.7 65±25.3 2.2±0.7 0 6.2±2.3 C 269±31.3 a 8.9±2.8 a 13±6.3 a 3.8±0.55 ab 3.5±0.53 NC 262±33.8 a 6.2±2.9 a 9±5.9 a 3.8±0.66 a 2.2±0.62 a P <0.05 NC b P >0.05 E 0.6±0.3 942±311 0.96±0.41 5.0±1.6 16±3.2 N 3.2±1.3 ab 617±245 ab 0.90±0.35 3.4±1.3 ab 13±4.3 C 0.8±0.2 908±232 0.89±0.46 4.8±1.5 11±2.6 ab NC 3.3±1.1 a 595±255 a 0.95±0.38 3.4±1.4 a 10±2.4 a P <0.05 NC b P >0.05 0.05) 4 2.5 4 (P >0.05) NC 5

5 MMJC May 2012 Vol 14 No.5 25 5 4 (%n=88) E 1(1.13) 9(10.23) 8(9.09) N 0(0) 5(5.68) c 0(0) ab C 1(1.13) 0(0) a 6(6.81) NC 0(0) 0(0) a 0(0) ab 6(6.81) 1(1.13) a 0(0) a 0(0) a P <0.05 N b P <0.05 24(27.3) 6(6.82) ab 7(7.95) ab 0(0) a b P <0.05 C [5] [6] 32% ~47% [57] [4] 3.2 3 (Bispectral indexbis) (Auditory evoked 3.1 potentialaep) NT EEG (EEG) Kugler 6 14 4 : 0~2 0~2 D0~2 E0~2 F0~1 α β γ δ A ;B ;C ;D ;E [8] ;F 0~ 100 (100= 0= ( ) ) [9] ; ; ; [23] ; [10] CLMRIS 4 4 3.3 NT CLMRIS 4 ( ) NC 3.3.1 NC Copper ( posttrumti stress disorderptsd) E Copper [4] NT

26 5 MMJCMay 2012 Vol 14 No.5 CLMRIS TOF NT (EEG) Copper E 3 ; 20s CLMRIS NT 0 3.3.2 NT NC E N C NT 3.3.5 NT E ;N NC NTS NTI CLMRIS CLMRIS C NC TOF 4 E 3.3.3 NC NTS NTI 3 N 1 NT E Ramsay NT ( ) NT CLMRIS 3.3.6 NT 3.3.4 E NT CLMRIS C 1 ; E C NT CLMRIS NT NT NT CLMRIS

5 MMJC May 2012 Vol 14 No.5 27 ( ) NT CLMRIS 1. [J]. 200718(23):1792 2. NT CLMRIS 200612(4):305 N C 3. 200813: 3.4 NT 159 NT 4 Sebel PS Bowdle A GhoneimMM et al. The incidenceof awareness during anesthesia: a multicenter UntiedStates study[j]. Anesth Analg200499:833-839 NT 5. 201026(11):941-943 6 Cammu G Witte G D Veylder GD et al.postoperative residual paralysis in outpatients versus inpatients [J]. Anesth Analg 2006 102(2):426-429 CLMRIS 7 Murphy GSSzokol JWMarymont JHet al.residual paralysis at 1 the time of tracheal extubation. Anesth Analg2005100:1840 - CLMRIS TOF 1845 8.Narcotrend. > 2009:326-332 > [11] 9 Sehneide JGKochs EFHom Bet al.narcotrend does not adequately detect the transition betwean awareness and unconscious- (TPS) ness in surgical patients.anesthesiology2004101(5):1105-1111 ; 10. 200713 (6):437-438 11. 2004 25(4):234-236 NT ( :2012-03-30)