Comparison Between The Effects Of Propofol And Isoflurane To The Patients Undergoing Laparoscopic Cholecystectomy

ObjectiveTo observe the effect of two anesthesia maintained with propofol target-controlled influsion(TCI) or isoflurane inhalation to the function of respiratory & circulation systems & RAS and to the level of plasm renal activity, angiotensin-Ⅱ &motilin during laparoscopic cholecystectomy(LC), and evaluate the role of auditory evoked potential index (AAI) in the monitoring of anesthesia.Methods1 .General materialsSeventy-two ASA-I patients for elective LC were randomly allocated to two groups. Their age is 21-60,weight 47-73Kg,and exclude respiratory , circulation and other system diseases.2. GroupThe patients were randomly allocated to two groups.Group I(n=38): the patients were intubated after induced and maintained with inhalation of isoflurane and nitrous oxide. Group P(n=34): the patients received the same induction and after intubation,anesthesia was maintained with propofol TCI and nitrous oxide inhalation.We adjusted the concentration of isoflurane inhalation or propofol TCI to control the MAP, HR within the range of ±20%the basic levels.3. observationWe recorded MAP, HR, PETco2, MV, PIP , CTCI, Eti and AAI at six time points: 10 min after entering the operation room(baseline), 0,5, 10, 15, 20 min during the pneumoperitoneum(T1-T5) and immediately after the pneumoperitoneum(T6). And also we observed the incidence and the severity of the postoperative nausea and vomiting(PONV),caculated the coefficient of variance (CV) .After the operation we inquired if they had bad feelings or recallings.4.DetectionBlood samples were taken 5 min before the pneumoperitoneum (tl) and immediately when the pneumoperitoneum was over (t2) for determination of PRA , AT-IK MTL.5.Statistical analysisChoose SPSS 11.0 software to analyse,mean±standard express quantitative data,and use t-test to analyse. To analyse the correlation between CTci> Etk MAP , HR and AAI.Use Ridit analysis to evaluate the incidence and the severity of the postoperative nausea and vomiting(PONV). PO.05 were considered significant.Results1. Comparision of the effect to the function of respiratory & circulation systems:The Petco2 and PIP are significantly enhanced,and MV are significantly decreased at T2-T6 after pneumoperitoneum in both Group P and group I (P<0.05) ,but there are no diffence between the two groups (P>0.05) . The MAP and/or HR are still significantly enhanced at T2-T6 after pneumoperitoneum in both Group P and group I (P<0.05 ) .2. The the level of plasm renal activity and angiotensin- IIThe the level of PRA and AT-II are significantly enhanced at ti time than at t2time (PO.05 ) . At t2time the level of AT-II are significantly higher in Group I than in Group I (PO.05) .3. The level of MTLThere are no diffence between the two groups at tj time, at t2 time the level of MTL are significantly higher in Group P (P<0.05) ,but there are no obvious change in Group I (P>0.05) .4. The incidence and the severity of the postoperative nausea and vomiting(PONV)The incidence and the severity of the PONV are significantly less in Group P than in Group I (PO.05) .5.The values of AAI are low and have transient AAI ^10 in both groups,thereinto there are 12 times in the group P and 4 times in the group I; and the values of AAI are correlated with the concentration of propofol TCI and the end-tidal concentration of isoflurane in a negative linear manner(P<0.05),but they have no linear correlation with MAP and HR(P>0.05).6. The coefficient of variance ( CV )The coefficient of variance of MAP and HR are both higher in Group I than in Group P (P<0.05) .Conclusions1.Neither of the two anaesthesia can suppress the effect of pneumoperitoneum to the respiratory & circulation systems completely, but by propofol TCI can suppress the response of stress better than isoflurane.2. It is not quite appropriate to regard the hemodynamics as the basis of anesthesia management. Using AAI during the common monitoring of anesthesia can provide us a more comprehensive reflection to the depth of anesthesia,thus we can regulate the dosage of anesthetics in the aim of avoiding...