Clinical Study Of The Effects Of Penehyclidine Hydrochloride As Premedication In Patients Undergoing Laparoscopic Surgery

BackgroundLaparoscopic surgery has been widely used in clinic because of the fllowing advantages: little hurt, less tissue damage, rapidly recovery from surgery, short time of be hospitalized, better cosmetic effect. Artificial pneumoperitoneum is required in this kind of surgery to form adequate space, facilitate peek and manipulation. Studies indicated that most complications of laparoscopic surgery are not caused by inappropriate manipulation, carbon dioxide and the followed high pressure in abdominal cavity have certain effects on physiology function of body. In circulation system, it may manifest increased blood pressure, rapid heart rate, arhythmia and increased myocardial consumption of oxygen.This study observed the change of patient's blood pressure and heart rate, the concentrations of Aâ…¡and IL-6 in vein blood of the patients premedicated with anticholinergic-penehyclidin hydrodnoride (PH) or atropine undergoing laparoscopic cholecystectomy, to evaluate the effects on myocardial consumption of oxygen and stress reaction.Materials and Methods45 patients undergoing laparoscopic cholecystectomy, ASAâ… -â…¡, aged 25-55, were randomly divided into three groups, intramuscularly injected atropin 0.01 mg/kg before the operation(group A), PH 0.01 mg/kg(group P₁), PH 0.02 mg/kg(group P₂). The patients were monitored ECG, HR, BP, SPO₂, P_ETCO₂ after arrivaing the operate room, Anesthesia was induced with fentanyl 2.5μg/kg, propofol 2 mg/kg, succinylcholine 1.5-2 mg/kg. The patients are mechanically ventilated after intubation (TV: 8-10 ml/kg, RR: 12-14 pm, I:E=1:2), the anesthesia was maintained with isoflurane, oxygen and nitrous oxide, the depth of anesthesia was maintained at 1.2 MAC, The P_ETCO₂ was maintained at 35-40 mmHg, controlled blood pressure changes less than 20% of baseline. The pressure of pneumoperitonenm was reached at 12-14 mmHg. The SBP, HR were recorded at the following times: before drug given(T₀), before anesthesia induction(T₁), after intubation(T₂), before insufflation(T₃), instant insufflation(T₄), 10 minutes after insufflation(T₅) and 10 minutes after stoping insufflation(T₆), calculated SBPxHR, the Aâ…¡and IL-6 in invenous blood were measured at T₀, T₅, T₆.ResultsThere were no significant difference among the three groups in age, weight, sex and time of surgical procedures, blood loss, infusion dosage, blood pressure and heart rate. The SBP and DBP of the three groups have no signifficant change after premedication, and increased significantly after intubation, but no statically significance. They decreased compared with T₃, in group P₁ the change of SBP has statistically significance compare with the basic(P＜0.05). regarding heart rate, the HR at T₁,T₃ in group A increased significantly compared with those of group P₁, P₂(P＜0.05), the HR at T₁, T₂ in group A and at T₂ in group P₁ increased compared with those of the basic(P＜0.01).The SBP×HR at T₃,T₄, T₅ in group A increased significantly compared with that of group P₁, P₂(P＜0.01), the SBPxHR at T₂ in group A increased compared with the baseline. The Aâ…¡at T₅ in group A increased compared with the baseline(P＜0.05), the IL-6 at T₆ in group A increased compared with that of group P₁ and P₂(P＜0.05), decreased in group P₂ compared with the baseline.ConclusionsPH as premedication can provide stable perioperative hemodynamic state, decrease myocardial consumption of oxygen and stress reaction compared with atropine in the patients undergoing laparoscopic cholecystectomy.