Effects Of Propofol On Oxidative Stress, Hepatic Function And Myocardium Injury In Laparoscopic Cholecystectomy

Objective: To study the effects of propofol on oxidative stress, hepatic function and myocardium injury of the patiens undergoing laparoscopic cholecystectomy (LC).Methods: Fifty ASAⅠorⅡpatients aged 18~65 years undergoing LC were randomly divided into isoflurane group (group I) and propofol group (group P) of 25 patients each. Patients were excluded when the analysis could not be completed due to severe errhysis or short (<30min) and long (>60min) pneumoperitoneum time, or when surgical findings necessitated conversion to open surgery. There was no difference between the two groups in terms of premedication. In all patients, anesthesia was induced with fentanly 3μg/kg, etomidate 0.3 mg/kg and scoline 1mg/kg,then vecuronium 1～1.2mg/kg was administration after tracheal intubation,ECG, HR, BP, SPO2, PETCO2 and End-tidal isoflurane were continuously monitored during operation. Group I, anesthesia was maintained with isoflurane, End-tidal isoflurane was maintained with about 1.3 MAC during the operation period. Group P, anesthesia was maintained with plasma concentration 2.0～2.3μg/ml propofol infusion administered by TCI pump. The doses of propofol or isoflurane was adjusted on the basis of cerebral state index, to maintain 45~60 during operation, vecuronium 0.5mg/kg and fentanly1～2μg/kg were administrated interval 30 min. A Verress needle was blindly inserted through a small umbilical incision, intra-abdominal pressure set at 14mmHg by CO2 pneumoperitoneum duing surgery. Medicines were adjusted if blood pressure exceeded 20% value of basic, but Ca2+ channel blocker was not administrated during operation.Blood samples were obtained from the superficial venous system of the upper extremities immediately before indution of anesthesia (T0) and 5 min after deflation of the pneumoperitoneum (T1) from the patients of both groups, indexes of oxidative stress in plasm which included in malondialdehyde (MDA), hepatocuprein (SOD), glutathione peroxidase (GSH-PX) and total antioxidant (T-AOC) were measured by these samples.another blood samples were obtained from the same sites immediately before indution of anesthesia and 24 h after surgery (T2)the patients of both groups,which were used to measure hepatic function, myocardium enzyme and troponin I in serum.Indexes of oxidative stress were examined by colorimetry, myocardium enzyme and troponin I were examined by methods what were introduced in agent kit's instruction.Measurement data were expressed as mean±standard deviation and deal with statistic soft SPSS11.5.Paired t-test was used between different times in each groups, independent samples t-test was used between two groups in the same time. Chi square test was used numeration data. A p value of <0.05 was considered significant.Result: Five patients were excluded during experiment in each groups, there were 20 patients in each group. There was no statistically significant difference between the two groups in terms of age, sex, weight index, or pneumoperitoneum duration. There was no statistically significant difference between the two groups in terms of indexes of oxidative stress, hepatic function, myocardium enzyme and troponin I before surgery.Indexes of oxidative stress: MDA group I and group P immediately before indution of anesthesia (6.5±2.3 nmol/ml and 6.4±2.0nmol/ml) were significantly lower compared with 5 min after deflation of the pneumoperitoneum (9.3±3.3nmol/ml and 7.1±1.9nmol/ml) ( P<0.01 and P<0.05), group P was significantly lower compared with group I at T1(P<0.05). SOD group I and group P immediately before indution of anesthesia (77.9±13.8U/ml and 77.8±9.3U/ml) were significantly higher compared with 5 min after deflation of the pneumoperitoneum (64.3±14.4U/ml and 73.9±10.2U/ml) ( P< 0.01 and P<0.05), group P was significantly higher compared with group I at T1(P<0.05). GSH-PX group I and group P immediately before indution of anesthesia (204.5±42.6U and 222.3±39.5U) were significantly higher compared with 5 min after deflation of the pneumoperitoneum (169.2±54.7U and 208.6±33.5U) ( P<0.01 and P<0.05), group P was significantly higher compared with group I at T1(P<0.05). T-AOC group I and group P immediately before indution of anesthesia (12.5±8.3U/ml and 13.3±7.2U/ml) were significantly higher compared with 5 min after deflation of the pneumoperitoneum (7.3±4.2U/ml and 11.4±5.7U/ml) ( P<0.01 and P<0.05)), group P was significantly higher compared with group I at T1(P<0.05). Hepatic function: alanine aminotransferase (ALT), aspartate aminotransferase (AST) and bilirubin total (T-BIL) group I and group P immediately before indution of anesthesia were significantly lower compared with 24 h after surgery(P<0.01), group P ALT(43±14IU/L), AST(46±16IU/L), T-BIL(19±4umol/L) were significantly lower compared with group I ALT(56±20IU/L),AST(57±16IU/L),T-BIL(21±3umol/L)in at T2( P<0.05). Myocardium enzyme and troponin I: lactic acid dehydrogenas(eLDH), hydroxybutyrate dehydrogenase (HBDH) and creatine kinase (CK) groups I immediately before indution of anesthesia (131±22IU/ L,98±18IU/ L,70±22IU/ L) were significantly lower compared with 24 h after surgery(159±26IU/L, 114±19IU/ L, 228±121IU/ L)( P<0.01), groups P immediately before indution of anesthesia (128±18IU/ L,95±17IU/ L,68±22IU/ L) were significantly lower compared with 24 h after surgery (156±26IU/ L, 114±21IU/ L, 222±160IU/ L)( P<0.01), but there was no significant difference between group I and group P at T2(P>0.05). Creatine kinase-MB (CK-MB) and troponin I there were no significant difference between before surgery immediately before indution of anesthesia and 24 h after surgery in two groups(P>0.05), there were no significant difference between group I and group P at T2(P>0.05).Conclusion: Organism can induce refusion injury and oxidative stress by CO2 pneumoperitoneum in laparoscopic cholecystectomy. The infusion of emulsified propofol at this specific dose(plasma concentration 2.0～2.3μg/ml) is better to exerts a real scavenging action, minimizing oxidative stress and recovering hepatic function. Myocardium is not injuried in laparoscopic cholecystectomy. The specific dose of propoful can't complete suppression oxidative stress in laparoscopic cholecystectomy.