Effect Of Target Controlled Infusion With Propofol And Remifentanyl On Laparoscopic Cholecystectomy

To observe the effect of two anesthesitic methods of propofol and remifentanyltarget-controlled influsion ( TCI ) or isoflurane and nitrous oxide inhalation onthe function of respiratory, circulation systems, airway pressure, nausea, vomitting, thelevel of cortisol (COR) & Interleukin-6 (IL-6) during laparoscopic cholecystectomy( LC ) , meanwhlie to evaluate the Bispectral index (BIS) under the monitoring ofgeneral anesthesia.Methods1,General materialsSixity ASAâ… -â…¡patients for elective LC were randomly divided into twogroups.Their age range is 40-60, body weight index〈25kg/m²,all excluded respiratory,circulation and other system diseases.2,GroupingThe patients were randomly allocated to two groups.Group P ( n=30 ) : thepatients were intubated after induced and maintained through Total intravenousanesthesia (TIVA) with propofol and remifentany TCI.Group I ( n=30 ) : the patientswere intubated after induced and maintained with inhalation intubation of isofluraneand nitrous oxide, adjust the concentration of isoflurane inhalation or propofol andremifentany TCI to control the MAP,HR within the range of±20% the basiclevels.Intravenous injecting vecuronium interruptedly so as to maintain musclerelaxation. Anesthetics of all patients of two group after operation would be stopped.3,Targets observedBlood samples were taken and recorded targets and BIS at six time points :10minafter patients entered the operation room(baseline) (T0) , starting aeroperitoneum (T1), 5(T2),10(T3),15(T4),20min(T5) during the pneumoperitoneum and immediately afterthe pneumoperitoneum (T6) . Targets observed were as followings.(1) record MAP andHR.at patients entering romm(T0) , starting aeroperitoneum (T1) , afteraeroperitoneum5min (T2) ,10(T3) , 15(T4) , 20min(T5) and release gas (T6) (2) PETCO2,Mv and PIP at starting aeroperitoneum (T1) , after aeroperitoneum5min(T2) ,10(T3) , 15(T4) , 20min(T5) and release gas (T6) respectively. (3) Bispectral index(BIS). (4) awareness. (5) Incidence of the postoperative nausea, vomiting(PONV)at 24 hafter the operation. (6) level of cortisol (COR) & Interleukin-6 (IL-6) at 10min patientsentered and after 20min of aeroperitoneum.4,Statistical analysisSPSS 11．0 software was used to analysize all quantitative data. Mean±standarddeviation indicated quantitative data,and use t-test to analyse. P<0．05 were consideredsignificant difference.Results1 Comparision of the effect to the function of of respiratory &circulatory system.PIP significantly enhanced at T2-T5 and PETCO2 significantly enhanced atT3-T6 both Group P and group I (P<0．05) .but MV significantly decreased afteraeroperitoneum at T2-T5 both Group P and group I (P<0．05) . PETCO2,PIP and MVwere not significant diffenence at any time between the two groups (P>0．05) , but MVwas not different obviously(P>0．05) .MAP and/or HR at T1-T6 afterpneumoperitoneum was no diffenent in group P (P>0．05) but significant different ingroup I(P<0．05) at T2-T5 in comparison with T0．2 The level of COR and IL-6There was no significant diffence between at t2 and t1 in group P (P>0．05) butsignificant diffence in group I(P<0．05) .3 Bispectral index BISThere are no significant diffence at T₁-T₆ between the two group and nosignificant differece within each group(P>0．05) .4 awareness No awareness occurred 8-12hr after operation.5 The incidence of the postoperative nausea and vomitiing(PONV)The incidence and the severity of the PONV was significantly less in Group P thanin Group I (P<0．05) .Conclusions1 The anaesthesia through TIVA with propofol and remifentany TCI caneffectively suppress the effect of of stress leaded by operation and pneumoperitoneumin laparoscopic cholecystectomy and maintained the stabilization of hemodynamicsand respiratory,which is better than inhalational anesthesia2 Hemodynamics monitoring associated BIS can provide us a morecomprehensive the depth of anesthesia,thus we can regulate the dosage of anesthetics inthe aim of avoiding awareness or extremely deep anesthesia.3 The anaesthesia through TIVA with propofol and remifentany TCI can reducethe incidence and the severity of the postoperative nausea and vomiting moreeffectively than inhalational anesthesia.