After the patients entered the operating room, a Datex-Ohmeda anesthesia monitor was connected to monitor the entropy index. The stateentropy (SE), reactionentropy (RE), and SPI values were monitored using a GE Healthcare monitor (Helsinki, Finland). Both groups received target-controlled infusion (TCI) of dexmedetomidine (Dex) 0.8 μg/kg/10 minutes, intravenous tropisetron 5 mg, and intramuscular penehyclidine hydrochloride 0.1 mg/kg. After sedation, “eye sign” (Fig. 2 A) and “infantile sign”(Fig. 2 B) changes were assessed. According to the requirements of the surgical field, unilateral/bilateral QLB surgery was performed through the anterior approach under local anesthesia with ultrasound guidance. After the target site was determined, 0.50% lidocaine (Hebei Tiancheng Pharmaceutical Co., Ltd., Cangzhou, Hebei, China; approval number: H13022313; specification: 5 mL: 100 mg) and 0.20% ropivacaine (Shijiazhuang Siyao Co., Limited, Shijiazhuang, Hebei, China; approval number: H20203107; specification: 10 mL: 100 mg) in 20 ml 0.9% normal saline were injected into each side of group F. In group C, 20 mL 0.9% normal saline was injected on each side. Fifteen minutes after administration, the level of sensory block was assessed in all subjects using acupuncture.[12 (link)]After testing the block level, the anesthesiologist on duty opened the sealed envelope marked 2 and decided whether to administer the OFA based on the block plane test results. Total intravenous anesthesia was used in both groups. Anesthesia was induced and maintained with TCI of propofol 3 to 3.5 μg/mL and intravenous rocuronium 0.6 mg/kg in group F, or with TCI of propofol 3 to 3.5 μg/mL and remifentanil (Yichang Humanwell Pharmaceutical Co. Ltd., Yichang, Hubei, China; approval number: H20030197; specification:1 mg) 2 to 4 ng/mL and intravenous rocuronium 0.6 mg/kg in group C. Then, the 2 groups were fitted with a laryngeal mask airway 3 to 5 according to body weight, and 0.3 mg/kg rocuronium was added intermittently according to the need of surgery to maintain the entropy index value of 40 to 65 and SPI value of 30 to 50.
When blood pressure was low and the heart rate was slow, ephedrine and atropine were administered for symptomatic treatment. Patients in both groups received intravenous flurbiprofen axetil 50 mg during skin suturing, followed by patient-controlled intravenous analgesia with esketamine 0.015 mg/(kg·h) (total dose ≤ 50 mg) + flurbiprofen 200 mg + Dex 100μg + tropisetron 5 mg + 0.9%NS to 100 mL, 2 mL/h. Electrocardiography, BP, pulse oxygen saturation (SPO2), PETCO2, SE, RE, SPI, Steward score, extubation time, awake time, as well as the propofol, Dex, rocuronium, and diltiazem dosages were monitored in both groups.
When blood pressure was low and the heart rate was slow, ephedrine and atropine were administered for symptomatic treatment. Patients in both groups received intravenous flurbiprofen axetil 50 mg during skin suturing, followed by patient-controlled intravenous analgesia with esketamine 0.015 mg/(kg·h) (total dose ≤ 50 mg) + flurbiprofen 200 mg + Dex 100μg + tropisetron 5 mg + 0.9%NS to 100 mL, 2 mL/h. Electrocardiography, BP, pulse oxygen saturation (SPO2), PETCO2, SE, RE, SPI, Steward score, extubation time, awake time, as well as the propofol, Dex, rocuronium, and diltiazem dosages were monitored in both groups.
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