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21AnesthesiologyDepatrment, China-JapanUnionHosptialo fJ ilinUniverstiy,126thXian-Ta i
Avenue ,Changchun ,J ilin ,P.R. C ahin ,130021
2EndoscopicCenter, China-JapanU nn io Hosptialo fJ ilinUniverstiy ,126thXian-T Aa i venue ,
. R . P , n ili J , n u h c g n a h
C C ahin ,130021 r
o h t u a g n i d n o p s e rr o C *
: s d r o w y e
K C elos -loopadminisrtaitonsystem ,Bispecrtali ndex ,Sedaiton, Anesthesia.
t c a r t s b
A . Objecitves :To analyset he safety and ef ifcacy o fvenou spropofo lsedaiton wtih close -c i p o c s o d n e g n ir u d s t n e it a p y lr e d l e n i ) S I B ( x e d n i l a rt c e p si b n o d e s a b m e ts y s n o it a rt si n i m d a p o o l
u c e s n o c 0 5 1 d e t c e l e S : s d o h t e M . ) P C R E ( y h p a r g o l a h p e c n e o rt c e l e e d a r g o rt e
r itve eldelry paitent s
,s e r u d e c o r p P C P E g n i o g r e d n
u ane tshe isaby propofo lsedaitono fclose-loop adminisrtaiton sy tsem 0
6 t a t e g r a t S I B h ti
w .Paitent swere divided i nto 3 group saccording t o t hei rage :group A ,50- 70 1
7 d e g a , B p u o r g ; ) 0 5 = n ( d l o s r a e
y -80 (n=50 ;) group C ,olde rthan 80 year s(n=50) .Propofo l e b o t a t a d e m ir p e h t e r e w P C R E g n ir u d ) a i m e a x o p y h d n a n o is n e t o p y h ( st n e v e e s r e v d a d n a e g a s o d
. st n e it a p r e d l o r o f e l b a ti u s e r o m e b t h g i m l o f o p o r p f o n o it a rt n e c n o c t e g r a t r e w o L : st l u s e R . d e d r o c e r
r a t n a i d e
M ge tconcenrtaiton are respecitvely 2.6μg/mL,2.1μg/mL and 1.6μg/mL fo rthe three o
p y H . s p u o r
g -ten ison i smore commonly happened in the younge rgroup ,and the incidence o f o
p y
h xaemiai s isgniifcanlty highe rin t heolde rgroups ,atlhough t heamoun to fadverseevent swa s ir e p o t n i d e n r u t e l b is s o p e r o m s a w ) g H m m 0 8 < ( e r u s s e r p d o o l b c il o ts y s e v it a r e p o e r p w o L . ll a m
s
-o p y h e v it a r e p
o -ten ison , paitent s wtih abnorma l pulmonary funciton wa s associated wtih s
u l c n o C . C d n a B s p u o r g n i a i m e a x o p y
h ions :Close-loop adminsirtati on sy tsem i s tsable and l
b a ti u s s i l o f o p o r p f o e g a s o d r e w o L . P C R E r o f a is e h ts e n a s u o n e v a rt n i r o f e l b a d n e p e
d efo relde lry
e h t h ti w s t n e it a
p samet arge tBISo f60 Moreattenitono fhypoxaemiashould bepaid t o t heeldelry m
r o n b a h ti w y lr a l u c it r a p , st n e it a
p a lpulmonaryf unciton.
n o it c u d o r t n I
a m r o f t n e m e g a n a m y l n o m m o c s i ) P C R E ( y h p a r g o t a e r c n a p o i g n a l o h c e d a r g o rt e r c i p o c s o d n
E ny
, s r e d r o si d y r a il i b o t a e r c n a
p commonblieduc t tsones ,pancreaitccancerf ori n tsance .Comparedwtih s
o d n e l a n it s e t n i o rt s a g r e p p
u copic procedures ,ERCP i smore itme-consuming and sophsiitcated i
m e s r o n o it is o p t n e b m u c ir t n e v h ti w e r u d e c o r
p -pronaiton t ha tmigh tber oughf o rane tshe isadocto r m
o c e l d n a h o
t pilcaiton[ 1] .EldelrypaitenstundergoingERCPmaybevulnerablef o radverseevent s ir
u
d ngsedaitonand i n t hepo tsoperaitvepeirod [ 2 .]Themos tcommon compilcaitonsi n ERCPwtih o
p y h g n i d u l c n i n o it a d e
s -ten ison , vasovaga l epsiodes , hypoxaemia , hypo-ventliaiton , ariway t
c u rt s b
o ion ,apnoeaandarrhythmia[ 3 .] e b o t d e s o p p u s e r a s t n e it a p y lr e d l
E ane tshe isa by lowe rdosage o fsedaiton to achieve equa l t
e g r a t A . st n e it a p r e g n u o y h ti w d e r a p m o c s t c e ff e l a c i g o l o c a m r a h
p -con rtolledi snfu ion(TCI )sy tsem ,
which sit he computer-as is tsed pump enable sautomaitcally admin sirtatesedaitve drug saccording l
a o
t gortihm o fpharmacokineitc so feffect-stieorgan [4 ]Howeve ,r t he pharmacokineitc model i n st
n e it a p l a u d i v i d n i h c a e r o f l a n o s r e p d n a l a m it p o y r a n i d r o a rt x e e b t o n y a m p m u p I C T e h
t especially
d n a e g a d e c n a v d a r o
f concomtian t dsiease [5] . Bsipecrta l index (BIS ) montio irng i s an e h t g n i z y l a n a y b a is e h ts e n a f o h t p e d e h t s e if it n a u q t a h t d o h t e m d e s a b y h p a r g o l a h p e c n e o rt c e l e
n a g n i d i v o r p , e r o c s x e d n i n a e t a r e n e g o t m h ti r o g l a x e l p m o c a s e s u d n a m a r g o l a h p e c n e o rt c e l e
a r e v e w o H . ] 6 [ s s e n s u o i c s n o c f o t n e m e r u s a e m e v it c e j b
o ne tshe isadocto rneed t o alway sadju ts t he
g n ir o ti n o m S I B d n a p m u p I C T a f o n o it a n i b m o c e h t f o y ti li t u e h t , y lt n e c e R . n o it a i d a r o t e r u s o p x e
e s o l
c -loops y tsemwtih tsableBISt argetf o rendoscopic rteatmen twasr epo tredf o roperaiton[ 7 .] e
s o l c f o s e m o c t u o e h t n o n o it a m r o f n i d e ti m il s i e r e h t ,r e v e w o
H -loopadminsirtaitonfo rsedaiton
f
o ERCP paitent swtih differen tage. Thi s tsudy aimed t o evaluatet he safety and ef ifcacy o fBIS e
s o l c d e s a
b -loop sy tsem wtih targe t conrto l infu ison o f propofo l fo r paitent s du irng ERCP .
e r u d e c o r p
Methods
n g is e D y d u t S d n a s t n e it a P
e v it u c e s n o c 0 5
1 selecitve ERCP paitent sw ere enrolled a tthe endoscope cente ro fChina-Japan l
a ti p s o h n o i n
u o f iJilnuniverstiybetweenOctobe r2016 andSeptembe r2017 .Thes edaitonproposa l f
o n o is u f n i s u o n e v a rt n i
si propofol wtihaTC Isy tsem wtih tsableBIS 60 conrtolled by close-loop .
m e ts y
s Paitent swere divided i nto 3 group saccording t o ages :group A ,50-70 year sold (n=50) ; 1
7 d e g a , B p u o r
g - 80(n=50 ;)groupC ,oldert han80years( n=50) .Ba isci nformaitono feachpaiten t g
s a h c u s , d e t a l u c l a c e r e
w ender ,bodymassi ndex ,respriatoryf unciton , IN BP ,H , OR Sp 2.
g n i r o ti n o M d n a n o it a c i d e M
a is e h ts e n a l a e g n y r a h
P wa spe frormed wtih 2% ildocainetopica lspray before i n rtavenousi nfu ison m e ts y s r o s u fi r p i D e h t g n is u y b y ls u o n e v a rt n i d e r e ts i n i m d a s a w l o f o p o r P . s g u r d e v it a d e s e h t f o
e h t o t g n i d r o c c a t e s r e t e m a r a p c it e n i k c it e n i k o c a m r a h p e h t g n is u m e ts y s I C T a s i h c i h
w Marsh
n o it a rt si n i m d a e h T . 0 6 f o t e g r a t S I B e l b a ts r e d n u d e ll o rt n o c e r e w l o f o p o r p f o n o is u f n i e h T . l e d o m
m e ts y
s si t hecomplex both t arge tconrtol i nfu ison, 0A2 00 BIS montio r(Aspec tMedica lNewton , )
s s a
M Sy tsem ,s and PID conrtoller .The blood concenrtaiton o fpropofo la teach itme poin twa s t n e m e r u s a e m e v it c e j b o r o F . p m u p I C T e h t f o r o ti n o m e h t n o n w o h s d n a y ll a c it a m o t u a d e t a l u c l a c
e s o l c e h t ,s t n e it a p d e t a d e s n i s s e n s u o i c s n o c f o l o rt n o c y ll a c it a m o t u a d n
a -loop wa sused .The BIS
s S I B r e v e n e h W . 0 6 t a t p e k s a
w corewa schanged moret han ±10% r angeo f60 du irng procedure fl
e s s a w e t a r n o is u f n i e h t , d o ir e
p -d irvenadju tsedbyclose-loopconrtolledcompute.r1μg/kgf entany l n i m / L 2 ( n e g y x o h ti w h t a e r b s u o e n a t n o p s e r e w s t n e it a p l l A . t n e g a c is e g l a n a n a s a d e t c e j n i s a
w )by
e n o r p e h t n i t p e k e r e w d n a n o it a d e s g n ir u d a l u n n a c l a s a
n po isiton .When adverseeven t(SBP <80
d i u lf s u o n e v a rt n i e h t n i e s a e r c n i e t a i d e m m i n a s a w n o it u l o s e h t , d e rr u c c o ) % 0 9 < 2 o p S r o g H m m
a d e s e h t g n ir u d d e rr u c c o a i m e a x o p y h f I . w o lf n e g y x o r o n o is u f n
i iton ,chin l fi ton t he paiten tand
. d e m r o fr e p s a w e s o d n e g y x o e h t d e s a e r c n i
p S d n a , m a r g o i d r a c o rt c e l e , e r u s s e r p d o o l b , e t a r e sl u
P O2weremon tioredcon itnuou lsydu irngt he
. e r u d e c o r
p The record o fblood pressure was intermitten tby 5 minutes .Majo rdata ea r abou t a
i m e a x o p y
h (Spo2<90% )and hypo-ten ison (SBP<80 mmHg) ,and the tota lpropofo ldose were .
P C R E e h t g n ir u d d e d r o c e r
si s y l a n A l a c it si t a t S
r o e g n a r d n a n a i d e m e h t s a d e t n e s e r p e r a s e l b a ir a v s u o u n it n o
C inter-quatrlie range I(QR) .
s u o u n it n o c f o n o si r a p m o
C vairable swa spefrormedbyt heMann-WhtineyUt e ts ,andcomparsiono f t c a rt x e o T . n o is s e r g e r c it si g o l d n a t s e t t c a x e r e h si F e h t g n is u y b e d a m s a w s e l b a ir a v s u o m o t o h c i d
( n o it a d e s l o f o p o r p g n i n r e c n o c s t n e v e e s r e v d a r o j a m f o h c a e r o f s r o t c a f t n a c if i n g
is hypo-ten ison ro
a i m e a x o p y
h ) .The isgniifcancel eve lwa sse ta tP<0.05 .Ther esutlan tdatawereevaluated by u isng )
C N , y r a C , e t u ti ts n I S A S ( 1 1 n o is r e v e r a w tf o s P M J
Resutls
d e c o r p , x e d n i s s a m y d o b , r e d n e g n i s p u o r g n e e w t e b s e c n e r e ff i d y ll a c it si t a ts o n e r e w e r e h
T ure itme
e h
T iniitaltarge tconcenrtaiton sw a respecitvely2.6μg/mL,2.1μg/mLand 1.6μg/mLfo rthet hree .
s p u o r
g Theolde rpaitentneededl owersedaitonconcen rtaitonatt hebeginning o fERCPprocedure . l
a t o t e h
T amounto fpropofo lwasl owe rtsfo oldes tpaitenti nt het hridgroup(seet able1 .) i
d d a n
I iton ,there were no isgniifcan tdi fference samong group sin the percentage so fSpo2 . o
p y
H -ten ison (a sdeifned by SBP<80 mm Hg) t ended t o occu ra thigheri ncidencein t heyounge r ;
% 5 . 8 2 : B p u o r g ; % 6 . 5 3 : A p u o r g ( t n a c if i n g is t o n s a w e c n e r e f fi d e h t t u b , s p u o r
g group C :23.3% ,
s g u r d r o s s e r p o s a v d e d e e n s t n e it a p 4 y l n O .) 2 7 0 . 0 =
P s,ucha sephed irne, dopamineo rnor-adrenailne
m o r f r e v o c e r o
t hypo-ten ison. Hypoxaemia occu rred isgni ifcanlty more o tfen i n t he olde ts group , p
u o r g ; % 0 : A p u o r g ( w o l s a w e c n e l a v e r p e h t t u
b B :2.6% ;group C:5.5% ,P=0.001) .Al lpaitent s
m o r f d e r e v o c e
r hypoxaemiawtihin30s econdswtihchin-lfi tmaneuver ,andnopaiten tneededmask t
n a ts is s
a breath o r rtachea lintubaiton .In addiiton ,n o paitent sha sdramaitcally body-movement . .)
1 e l b a t e e s (
Table1 .Charactersiitc so fprocedure sandadverseevents.
Charactersiitcs GroupA( 50 -) r a e y 0
7 Gr8o0uypeBar( )71- (G>r8o0yupeaCr) Pvalue
m / g k ( I M
B 2) 22.4(20.5-24.4) 22.8(21.0-25.0) 22.5(20.7-24.8) 0.076
) n i m ( e m it e r u d e c o r
p 43.5(34.8-72.3) 48.0(38.0-8 )8 .2 46.0(37.6-90.4) 0.093
l o f o p o r p f o n o it a rt n e c n o c m u m i n i M
) L m / g μ
( 1.8(1.4- )2 .0 1.6(1.2- )1 .8 1.3(1.0- )1 .7 <0.003
l o f o p o r p f o n o it a rt n e c n o c m u m i x a M
) L m / g μ
( 3.3(2.6- )3 .8 2.9(2.4- )3 .6 2.6(2.0- )3 .2 <0.001
l o f o p o r p f o n o it a rt n e c n o c e g a r e v A
) L m / g μ
( 2.6(2.2- )3 .2 2.1(1.7- )2 .8 1.6(1.5- )2 .5 <0.001
) L m ( l o f o p o r p f o e s o d n o i s u f n i l a t o
T 43(30- )6 2 35(23- )4 8 30(18- )4 0 <0.001
e c n e d i c n i n o it n e t o p y H
) % () g H m m 0 8 < P B S
( 3 5.6 2 8.5 2 3.3 0.072
e c n e d i c n i a i m e x o p y H
) % () % 0 9 < 2 o p S
( 0 2 .6 5 .5 0 .01
Dsicus ison
a d e s p e e
D iton i n den oscopic rteatmentf o rolde rpaitent sare ilmtied[ 7,8] .Thsir epor tevaluatedt he y
c a c if f
e ands afetyoft heTC /IBISclose- ploo sedaitonsy tsemdu irngERCPf ordifferen tagepeirod r
o f y ll a i c e p s
e elde rones .According t o t her esul to fourr esearch,t herewa sanobviou sco rrelaiton n
e e w t e
b median concenrtaitono fpropofo l da n age .Theolderpaitent swa ,st hel owe rconcenrtaiton e
s o l c h ti w l o f o p o r p f o e s o d d n
a -loop TC /IBIS i nfu ison sy tsem .Wtih r egard t o adverseevent ,s t he f
o n o it r o p o r
p hypo-ten ison wa shighes tin younge rgroup ,wherea sthe incidence fo hypoxaemia (
s p u o r g r e d l o e h t n i r e h g i h y lt n a c if i n g is s a
w bothBandC) .However, et h actua lamounto fpaitent s h
ti
w such adverse even twas wl , o tha tmean sclose-loop TC /IBIS infu ison sy tsem i ssafety fo r m
i n i
m allyi nva isvesurgery sucha sERCP .Thepos isblereasonf o rhigheri ncidenceo fhypoxaemia t
a h t s a w C p u o r g n
i olde rpaitent sare accompanied wtih abaitng o fpulmonary funciton such a s )
D P O C ( e s a e si d y r a n o m l u p e v it c u rt s b o c i n o r h
c .Hypo-ten isonmoslty occurred i nt hemaintenance d
o ir e
p becauseoft hesharp decilneo fproceduresitmulate ,wherea shypoxaemiaoccu rred i n both e
h
t induce and maintenance peirods o fane tshe isa in the reason o fobsrtuciton o fariway and e
d h t a e r b s u o e n a t n o p
s pres ison o fpropofol . iDfferen tfrom open-loop TC Isy tsem, t he close-loop I C T e t a l u p i n a m d n a r o ti n o m S I B o t g n i d r o c c a h t p e d a is e h ts e n a h c t e f n a c S I B n o d e s a b m e ts y s
f o s e it l u c if fi d e v o m e r n a c m e ts y s e h T . r e ll o rt n o c D I P h ti w c it e h ts e n a e s u f n i o t r e p m u p
n a
m ipulaiton,i nconvenienceandi ndividua ldifferences ,makeane tshe isaproceduremore tsableand .
n o it a r e p o o t y s a
e Propofo lsedaiton i n t heeldelry paitent sdu irng ERCP wtih t heTC /IBIS close -p
o o
l sy tsemwa sequivalenti nt her espect so fsafetyandeffecitvecomparedwtihtheyounge ro . nes a
s i l o f o p o r
P commonly used n -on barbtiurate sedaitve hypno itc fo rcilnic pracitce .I tha sa y
t e f a s e h T . e m it y r e v o c e r tr o h s d n a t e s n o k c i u q s a e li f o r p c it e n i k o c a m r a h p e l b a r o v a
f and effecitve
r o f n o it a d e s l o f o p o r p f
o ordinary gasrtointesitna lendoscopy in elde lry paitent sha sarleady been .
] 9 [ d e tr o p e
f o n o it i b i h d
a propofo lshould becauitousr egarding t o relaitvely high i ncidenceo fdose-dependen t o
p y
h -ten ison and resp riatory depres ison [10] .Oncecardiorespriatory i nhibiiton ha soccu rred , tii s e
d i v o r p o t y r a s s e c e
n exrta and itmely suppor tun it lpropofol i smetaboilzed because t here are no .
e l b a li a v a s ts i n o g a t n
a Exrta man-made managemen ti smean sto X-ray exposure to ane tshe isa .
s r o t c o
d Toavoidexces isvei nfu isono fpropofol ,weusedt heBISmontio irngs y tsem ,whichmake s .
e l b is s o p n o it a d e s f o h t p e d e h t f o n o it a u l a v e e v it c e j b
o TheBIS value i sgenerally se ta t60 du irng
e w o h s a is e h ts e n a l a r e n e g h ti w s e r u d e c o r p l a c i g r u
s d ti seffecitveness[ 6 .] I n t he tsudy, t herewa san t a s e u l a v S I B n i a t n i a m o t l o f o p o r p f o n o it a rt n e c n o c t e g r a t e h t d n a e g a n e e w t e b n o it a l e rr o c e s r e v n i
r o f l o f o p o r p f o t n u o m a r e w o l a h ti w n o it a d e s e l b a ts n i a t n i a m o t e l b is s o p s a w t i , tl u s e r a s A . 0 6
y lr e d l
e paitenstt hanyounge rone swtihaTC /IBISs y tsem.I twass hownt ha telde lrypaitenstr equrie t l u s e r s i h T . ] 1 1 [ r e g n u o y n a h t n o it a d e s f o s l e v e l r a li m is h c a e r o t l o f o p o r p f o t n u o m a r e w o l a
p m u p I C T e h t y b n o is u f n i f o l o rt n o c t c ir ts t a h t s ts e g g u
s automaitcally adju tsed by close-loop it t
n o it a
r of t hei ndividua lsedaiton depth by BIS mon tio irng could decrease t he dose o fpropofoli n .s
t n e it a p y lr e d l e
,s g n i d n if r u o n o d e s a
B hypo-ten ison wa s frequen lty happened in the maintenance peirod, r
o f y ll a i c e p s
e younge rpaiten stt ha tneed smorepropofol .Becauseoft hes ho tr-acitngcharactersiitc s l o f o p o r p f o e s o d e h t n i s e s a e r c e d h ti w y l e t a i d e m m i d e r e v o c e r s t n e it a p l l a t s o m l a , l o f o p o r p f o
t a r d i p a r e r o m e h t y b d e n i a l p x e e b t h g i m t l u s e r e h T . g u r d r o s s e r p o s a v a g n is u t u o h ti
w eofi ncrease
o t d e d n e m m o c e r s a w m e ts y s g n ir o ti n o m S I B e h T . ] 2 1 [ s n o it a rt n e c n o c l o f o p o r p n
i reduce the
f o e c n e d i c n
i hypoxaemia and hypo-ten ison rf o the elde lry [13] . tI i sbeileved t ha t tsablitiy of t he l
c h g u o r h t s p u o r g t n e it a p r e d l o e h t n i e t a ts n o it a d e
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