Compare Propofol-remifentanil With Sevoflurane On The Protection Of Gastrointestinal Tract In The Gynecology Laparoscopic Surgery

Objective To evaluate the changes in hemodynamics,intramucosal PH (PHi) and intestinal fatty acid binding protein (I-FABP),and compare propofol-remifentanil with sevoflurane on the protection of gastrointestinal tract in the Gynecology Laparoscopic surgery.Methods Twenty patients underwent the elective surgery were randomly subjected to either group IA (Intravenous Anesthesia;n=10) or group SA (Sevoflurane Anesthesia;n=10) were included in this prospectiv study.Every patient was induced with the same intravenous anesthesia.After turacheal intubation, remifentanil (4～10μg/kg- 1·h– 1) and propofol (4～8mg/kg- 1·h– 1), atracurium (0.5～1mg?kg-1?h-1) were used for the maintenance of anesthesia in Group IA ,and sevoflurane (1.0-1.5MAC) and atracurium (0.5～1mg?kg-1?h-1) were used for the maintenance of anesthesia in Group SA.Measurements for HR,MAP,SpO2,PetCO2 were performed before insufflation (T1),15 min (T2) and 30 min (T3) into the operation (midinsufflation),15 min (T4) after desufflation.PgCO2,Pg-aCO2,Pg-etCO2,PHi were measured by using the gastrointestinal tonometry monitor. From every patient in the study the samples of arterial blood were taken for arterial blood gas analysis and venous blood samples were also collected form all patients in those intervals for the measurement of I-FABP levels in those intervals.Results There was no significant difference between the IA and SA groups in terms of preoperative situation, operation produres (P>0.05).At T2 and T3,tonometric measurements showed the PgCO2,Pg-aCO2,Pg-etCO2,I-FABP levels increased significantly in both anesthetic groups from the baseline values (T1) (P<0.05).The PHi concerntrations at T2 and T3 were significantly (P<0.05) lower than baseline at T1.The concerntrations above did not reture to baseline at T1 after desufflation (T4).The levels of PHi in group IA were lower than group SA at T3 and T4 (P<0.05).There were significantly (P<0.05) lower levels of I-FABP in group IA than group SA.Conclusions Compare to sevoflurane, propofol-remifentani have an advantage in attenuating the ischaemia/reperfusion (I/R) injury of the gastrointestinal, when underwent the Gynecology Laparoscopic surgery that kept the pneumoperitineum pressure (12mmHg).