The Application Of Different Concentration Target Control Infusion Of Remifentanil In Gynecological Laparoscopic Surgery

IntroductionLaparoscopic surgery had the features of a little injury and a quick recovery. In recent years, laparoscopic surgery developed widely all over the world. But high carbon dioxide effects the functions of respiration, circulation and internal secretion system. Target controlled infusion was a new intravenous anesthesia method, which could adjust anesthesia depth through maintaining the plasma drag concentration steadily, and made the intravenous anesthesia become more precise and efficient. Remifentanil were applied to TCI-based intravenous anesthesia gradually because its shorter continue-infusion half-time and less stress. In this study we observed the changes of hemodynamic, plasma concentration of cortisol and sugar during gynecological laparoscopic surgery by applying different target plasma concentration of remifentanil total intravenous anesthesia to investigate the most suitable concentration of remifentanil.MethodsForty-five ASA I - II patients undergoing elective gynecological laparoscopy were randomly divided into three groups, 15 patients each, group I , II and III. In three groups, we selected propofol and remifentanil induced and maintained with target controlled infusion anesthesia, which was stopped at the end of operation. In group I , II and III, the target plasma concentration of remifentanil was set at 4, 6 and 8ng/ml separately and propofol at 3μg/ml. SBP, DBP, MAP, HR, ECG, SpO₂, P_ETCO₂ were monitored during anesthesia. The following items were recorded. (1) the changes of HR, MAP and blood glucose and cortisol at ten minutes before anesthesia (T₁), one minute after tracheal intubation (T₂) ,20 minutes after peneumoperitoneum (T₃) and 20 minutes after insufflation was given off (T₄) . (2) the time of eye opening and tracheal extubating. (3) The extent of pain and complications of nausea and vomiting. (4) Awareness during operation. Applied SPSS 13.0 statistical software to do statistical processing. Use one way analysis of variance of two independent samples among three groups to compare different hour point in the measurement date group,use Chisquared test to compare enumeration date. P<0.05 have differences significantly.ResultsThe plasma level of cortisol in group II and group III at T3 and T4 were significantly lower than those in group I (P<0.01). Blood suger of group II and group III at T4 were little higher than those before anesthesia, but it has significant difference in group I (P<0.05).Heart rate of group I , II and III at T₂, T₃ have no differences (P>0.05), but were lower than those before anesthesia (P<0.01). Mean arterial blood pressure of group I , II and III at four time points have no differences(P >0.05), but were lower than before anesthesia at T₂ (P<0.01). Eye opening as requesting and tracheal extubating were similar among three groups .The incidence of postoperation nausea and vomiting were higher.DiscussionThe effects on the internal secretion in laparoscopic surgery are lower than the normal ways operation. But carbon dioxide peneumoperitoneum is still a stimulation to human body and led the obvious stress which adjust the changes of respiration and circulation. Stress response is a way to adjust itself, but the stronger response can reduce the reservation of physiology,even failure. To choose approapriate anesthesia methods and drugs can regulate and restrain stress response through restructuring the dose of anesthesia drugs.Our research results show the group I , II and III can depress the stress response to tracheal intubation effectively. Group II and group III can restrain the stress response to carbon dioxide peneumoperitoneum .In group III, MAP were lower but they were at the range of permission. Eye opening at request and tracheal extubation after operation were similar among three groups. These show that TCI may maintain plasma concentration steadily to control anesthesia depth and keep the hemodynamic stable.These embody remifentanil has the character of the better control and the shorter continue-infusion half-time. Even larger dose do not influence the recovery after operation. The plasma drug concentration reduced quickly after surgery and the pain appeared quickly, so we should use analgesia drugs earlier to relieve the pain.ConclusionIn the gynecological laparoscopic surgery induction and maintenance of anesthesia with TCI of remifentanil 4-8 ng/ml and propofol 3μg /ml can relieve the stress response to tracheal intubation effectively, TCI of remifentanil 6-8 ng/ml and propofol 3μg /ml can relieve the stress response to carbon dioxide peneumoperitoneum, moreover TCI of remifentanil 6ng/ml and propofol 3μg /ml intravenous anesthesia may achieve the stability of the hemodynamic and the better recovery after operation.