A Comparison Of Propofol Target Controlled Infusion With Sevoflurane Inhalation On Stress Response During Percutaneous Nephrolithotomy

Objective To compare the effects of propofol target controlled infusion withsevoflurane inhalation on hemodynamics and hormonere response to stress. MethodsForty patients scheduled for percutaneous nephrolithotomy were divided into twogroups with 20 cases each. The anesthesia was induced by TCI with propofol.Anesthesia was maintained with either sevoflurane inhalation (Group S) or propofolby TCI (Group T). The depth of anesthesia was controlled by BIS range from 40 to 60.ECG, SBP, DBP and HR were monitored continuously. The levels of plasma ACTH,Cortisol and BS were determined to five times points: 30 minutes after entering theoperation room in the morning (T1), 5 minutes after skin incision (T2), 15 minutesafter irrigation (T3), 60 minutes after irrigation (T4) and 15 minutes after extubation(T5). Results a. HR, SBP and DBP at all time points in two groups were in normalranges. There were no differences of SBP and DBP at each time points in two groupsand between the groups. At T3 and T4, HR in group P were significantly lower thanwhich in group S (P＜0.05), and there was no difference at other time points betweenthe two groups. CVP is significant higher at T5 than at T1 in both groups,, but therewas no difference between the two groups, b. In the two groups, the concentrations ofplasma ACTH at T3, T4 and T5 were all higher than at T1 (P＜0.05). Furthermore,those concentrations at T4 and T5 in group P were significantly lower than which ingroup S (P＜0.05). c. The concentrations of plasma Cortisol at T4, T5 in group S andat T5 of group P was higher than at T1 in each group. The concentration of plasmaCortisol at T5 of group P was lower than which in group S (P＜0.05). d. The bloodsugar at T3, T4 and T5 in both groups were significant higher than at T1 (P＜0.05).The concentration of blood sugar at T5 of group P was significant lower than which ingroup S (P＜0.05). Conclusions Stable cardiovascular function could be maintainedby either TCI of propofol or sevoflurane inhalation.during percutaneous nephrolithotomyHowever, TCI of propofol was more effective on suppression of neuroendocrine response than sevoflurane inhalation.