Study On Laparoscopic Cholecystectomy By Different Sufentanil Doses In Induction Period Under Laryngeal Mask Ventilation

Objective:To observe hemodynamic effects of different sufentanil does in induced general anesthesia period based on etropy index as a measure of hypnosis in cholecystectomy and to approach the feasibility of laryngeal mask ventilation and induced reasonable doses of sufentanyl under total intravenous anesthesia.Methods:The experimental protocol was approved by the Institutional Ethics of Committee of author's hospital.Written informed consent was obtained from each patient involved in the study. Sixty ASAâ… -â…¡patients under laparoscopic cholecystectomy were elected.Their BMI is below 30kg/m² . All the patients were randomly divided into three groups with 20 patients in each group:group S1 (sufentanil 0.2μg/kg),group S2 (sufentanil 0.4μg/kg),group S3 (sufentanil 0.6μg/kg).All the patients undergoing general anesthesia for induction receieved midazolam 0.04mg/kg, syn-atracurium0.08mg/kg and propofol 1mg/kg.Values of response entropy(RE),state entropy(SE),systolie blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP) and heart rate(HR) were recorded before induction(T0).The moment before laryngeal mask insertion(T1),1 minute after laryngeal mask insertion(T2),3 minute after laryngeal mask insertion(T3),5 minute after laryngeal mask insertion(T4),and at the same time,body movement,difficult insertion,air leak,backstreaming and aspiration,a sore throat after surgery were all observed and recorded at the time of laryngeal mask insertion under laryngeal mask ventilation for three days .Results:All the patients had a successful laryngeal mask insertion.No one had a body movement,tracheal intubation,difficult insertion and arrhythmia,two patients have intestinal tympanites.A patient needed to insert gastric canal,three patients had pharyngalgia after surgery,one patient had pharyngalgia respectively in group S1 and group S2.There was no statistical significance in age,weight,body height,ASA grade and other monitoring index(P>0.05);there was no statistical significance in values of pulse oxygen saturation(SpO₂) in three groups at different times(P>0.05);values of RE,SE,SBP,DBP,MAP,HR at T1 were lower than elementary values in all groups,there was a statistical significance(P<0.05).nevertheless, values of RE,SE,SBP,DBP,MAP,HR in group S₁ and group S₂ were higher than that in group S₃, and the above-mentioned monitoring index in group S₁ were higher than that in group S₂ and group S₃,there were no statistical significance on basic values of the above-mentioned monitoring index in three groups(P>0.05).Values of RE,SE,SBP,DBP,MAP,HR were obviously higher at T₂ than that at T₁,there was a statistical significance (P<0.05),which was slowly return to elementary values at T3 and T4;values of SBP,DBP,MAP,HR at T2 were higher than that at T₁ in group S2 and group S3 ,there was no statistical significance on the above values at T₀,T₁,T₂,T₃ and T₄ in group S2(P>0.05),but in group S3,the values of SBP,DBP,MAP and HR from T₂ to T₃ had a tendency of descending,the above values at T3 and T4 were lower than T1,there was a statistical significance at T₂ (P<0.05),SBP,DBP,MAP and HR in group S₁ were higher than that in group S₂ and group S₃, there was a statistical significance (P<0.05),there was no statistical significance when compared group S₂ with group S3(P>0.05),there was no statistical significance among values of RE,SE in group S-2,S₃ (P>0.05),there was no statistical significance on values of RE and SE at T₃ and T₄ when compared group S₁ with group S₂(P>0.05).there was a statistical significance on values of SBP,DBP,MAP and HR in group S1 were obviously lower than that in group S₁, there was a statistical significance(P<0.05).There was no statistical significance when compared with group S₂(P>0.05),There was no significant difference on values of RE and SE in three groups(P>0.05). Conclusions:1.Entropy can be used as an index of medication during surgery ,vital signs of patients can keep stable based on RE,SE as an indication of a depth of anesthesia.2.Laryngeal mask airway can be easily inserted with a less trauma of pharyngeal portion combined with syn-atracurium.3.Compared with the dosage of 0.2μg/kg sulfentanyl,the dosage of 0.4μg/kg and the dosage of 0.6μg/kg sulfentanyl can both effectively prohibit the stress responses under laryngeal mask ventilation.and Sufentanil 0.4μg/kg is the best dosage of the induction,it can better keep hemodynamic stabilization under laryngeal mask ventilation.4.Patients undergoing laparoscopic cholecystectomy have a little reaction under laryngeal mask ventilation , vital signs of patients are stable.