For patients requiring the heart valve replacement surgery, heart function is injured in different degree.Thus, minimizing the impact of the anesthesia drug on the cardiovascular system has important clinical meanings. Etomidate has slight effect on the cardiovascular system, often used in the induction of anesthesia, however target controlled infusion etomidate in maintenance of anesthesia is less used. So, the trial is designed to observe the application value of TCI etomidate in thoracoscopic mitral valve replacement surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
110
The initiate drug concentration of propofol is set to 1.0 μg/ml, increasing 0.3 μg/ml every minutes until the BIS(Bispectral index ) reaches 40\~60.
The initiate drug concentration of etomidate is set to 0.2 μg/ml, increasing 0.1 μg/ml every minutes until the BIS(Bispectral index ) reaches 40\~60.
BIS monitored from beginning of anesthesia induction to the end of the surgery.
Midazolam 0.03 mg/kg injection vein，Sufentanyl 0.5\~1 μg/kg, target controlled infusion of etomidate or propofol,after the consciousness of patients is lost, rocuronium 0.6mg/kg is given.
After the intubation, target controlled infusion(TCI) of etomidate or propofol is maintained,rocuronium 0.15mg/kg and sufentanil is given when needed. When the operation is over, the TCI is stopped.
After the induction of anesthesia, Tracheal intubation is performed.
Blood pressure
blood pressure(systolic blood pressure and diastolic blood pressure) is monitored and recorded at 9 time points, including 10 minutes before induction,the right moment after induction of anesthesia and tracheal intubation,the beginning of surgery and the cardiopulmonary bypass(CPB),the time the ascending aorta is blocked and unstuck,the time the CPB and the surgery is over.
Time frame: from the beginning of induction to the surgery over, up to 6 hrs.
Heart rate
Heart rate is monitored and recorded at 9 time points, including 10 minutes before induction,the right moment after induction of anesthesia and tracheal intubation,the beginning of surgery and the cardiopulmonary bypass(CPB),the time the ascending aorta is blocked and unstuck,the time the CPB and the surgery is over.
Time frame: from the beginning of induction to the surgery over, up to 6 hrs.
Delirium
Using Confusion Assessment Method for the Intensive Care Unit(CAM-ICU) to screening of delirium.
Time frame: The right moment of patients'leaving off PACU, expected to be 2 h from the end the of operation
Life quality
using the Activities of Daily Living (ADL) to assess the life quality one month after the surgery.
Time frame: at the time of one month right after the surgery
Number of Participants with Serious and Non-Serious Adverse Events
Number of Participants with Serious and Non-Serious Adverse Events including major adverse cardiovascular and cerebrovascular event such as cardiac infraction,stroke, acute renal failure, re-surgery,and death. Safety Issue?: Yes
Time frame: Up to 1 month
Time of recovery from anesthesia
Time frame: from the time TCI is stopped to the time patients' eyes open after the surgery, up to 30 minutes.
Bispectral index (BIS) value
BIS is monitored and recorded at 9 time points, including 10 minutes before induction,the right moment after induction of anesthesia and tracheal intubation,the beginning of surgery and the cardiopulmonary bypass(CPB),the time the ascending aorta is blocked and unstuck,the time the CPB and the surgery is over.
Time frame: from the beginning of induction to the surgery over, up to 6 hrs.
onset time
The time period from TCI etomidate or propofol to the disappearance of eyelash reflex.
Time frame: The time from TCI etomidate or propofol to the disappearance of eyelash reflex,up to 10 minutes.
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