Effect of Bispectral Index-Guided Propofol Combined with Remifentanil Target-Controlled Infusion on Intraoperative Propofol Dosage and Postoperative Delirium Incidence in Elderly Patients Undergoing Hip Arthroplasty
ZHU Leilei, WU Weiwei, GAO Wu, et al
The First Affiliated Hospital of Anhui Medical University, Anhui Hefei 230000, China
Abstract：Objective: To investigate the effect of bispectral index (BIS)-guided propofol combined with remifentanil target-controlled infusion (TCI) on intraoperative propofol dosage and postoperative delirium incidence in elderly patients undergoing hip arthroplasty.Methods: A retrospective analysis was conducted on the case data of elderly patients with hip fractures. According to the different anesthesia methods received by the patients, they were divided into two groups: the observation group included patients who underwent hip arthroplasty under BIS-guided propofol combined with remifentanil TCI , and the control group included patients who underwent similar surgery under BIS-guided propofol combined with remifentanil continuous intravenous pump infusion . A binary logistic regression analysis was established to construct a propensity score matching model. The results showed that 56 cases were obtained in the observation group and 49 cases were obtained in the control group. There was no significant difference between the two groups (P > 0.05). The parameters (mean arterial pressure (MAP), heart rate (HR)), general surgical conditions, propofol dosage, BIS value maintenance were compared between the two groups at different time points (after admission (T0), after anesthesia (T1), after bone cementation (T2), at the end of surgery (T3), after discharge (T4), 3 hours after surgery (T5) and 5 hours after surgery (T6)). The delirium scores (Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)) were compared between the two groups at different time points (preoperative and 1 hour, 6 hours, 1 day, 3 days, and 7 days after surgery). The incidence of postoperative delirium and the changes in blood glucose (Glu) and plasma adrenaline (E) and cortisol (Cor) levels at different time points (preoperative and 1 day after surgery) were recorded and compared between the two groups. Results: MAP value at T1 was significantly decreased in observation group compared with that at T0 (P<0.05), MAP value at T2 was significantly reduced in both groups compared with that at T0 (P<0.05), and HR value at T5, T6 and T7 in control group was significantly decreased compared to T4 (P<0.05). There were no significant differences in surgical time, anesthesia time and intraoperative blood loss between the two groups (P>0.05). The dosage of propofol in observation group was significantly less than that in control group (P<0.05), and the BIS target range maintenance time ratio was significantly longer than that in control group (P<0.05) while the recovery time, tracheal extubation time and orientation recovery time were significantly shorter than those in control group (P<0.05). At 1h, 6h, 1d, 3d and 7d after surgery, the CAM-CR score in the two groups was firstly increased and then decreased, and was significantly higher than that before surgery (P<0.05). The CAM-CR scores in observation group at 1h, 6h, 1d and 3d after surgery were significantly lower than those in control group (P<0.05). There were no significant differences in the score at 7d after surgery compared to before surgery and between the two groups at the same time point (P>0.05). The incidence rate of postoperative delirium in observation group was 5.36%, which was significantly lower than 18.37% in control group (P<0.05). The levels of Glu and plasma E and Cor in the two groups were significantly increased at 1 d after surgery (P<0.05), but the levels in observation group were significantly lower than those in control group (P<0.05). Conclusion: The application of BIS-guided TCI of propofol combined with remifentanil in elderly patients with hip replacement can stabilize the hemodynamics, improve the perioperative indicators, reduce the dosage of propofol, improve the maintenance of BIS value, promote the anesthesia recovery, reduce the risk of postoperative delirium, and relieve the body’ s stress response.
2024, Vol. 30 
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