Clinical Observation Of Sevoflurane-remifentanil And Propofol-remifentanil Anesthesia In Laparoscopic Cholecystectomy

Objective: To compare the effects of sevoflurane-remifentanil andpropofol-remifentanil anesthesia on hemodynamics and postoperativerecovery in patients undergoing laparoscopic cholecystectomy.Methods: Forty patients（ASA I or II, aged18to60） scheduled forlaparoscopic cholecystectomy were randomly divided intopropofol-remifentanil group（group PR, n=20） and sevoflurane-remifentanilgroup（group SR, n=20）. After intravenously midazolam0.05mg/kg andsufentanil0.3⁰.4μg/kg taken for each patient in both groups, patients ingroup PR ware induced with intravenous propofol1²mg/kg, while thepatients in group SR inhaled sevoflurance with8%concentration until fallinginto sleep and then inhaled sevoflurance of6%concentration, both groupsadministered rocuronium0.6mg/kg intravenously. The patients in group SRinhaled sevoflurane of2%to5%and those in group PR were infused withpropofol at the rate of2to5mg kg^-1·h^-1. At the same time, patients in bothgroups were infused with remifentanil at the rate of0.1to0.3μg kg^-1·min^-1.Remifentanil was stoped infusion at the time of stoping pneumoperitoneum.At the end of surgery, all the anesthetics were stoped, and the awakeningcondition was observed. The depth of anesthesia was adjusted by Narcotrendmonitor. Sedation-Agitation Scale（SAS） and Visual AnalogueScale/Score（VAS） were used to measure the condition of emergence agitationor pain. Time duration of patients having breath, opening eyes and extubationwere observed. The changes of heart rate（HR）, systolic blood pressure（SBP）,diastole blood pressure（DBP）, end-tidal cardon dioxide（ETCO2）, pulseoxygen saturation （SPO2） and NT were observed at the time points of beforeinduction（T0）, immediately after intubation（T1）, at skin incision（T2）,5 min after pneumoperitoneum（T3）, immediately after completion of theoperation（T4）, having bteath（T5）, opening eyes（T6） extubation（T7）. Untowardeffects of the patients were also observed after operation.Results: After comparing with those of T0, the SBP and DBP weresignificantly lower at T1and T2（P<0.05）, especially in group SR; The SBPand DBP were lower at T3than those at T0（P<0.01） in group SR, while thedifference in group PR changes was unremarkable. There was significantdifference in DBP at T3and T4between the two groups（P<0.05）, but not atthe other points time（P>0.05）. No significant difference was found in HR andNT between the two groups. Compare with that in group PR, the incidence ofuntoward effects was unremarkable in group SR（P>0.05）.Conclusions: Propofol-remifentanil and sevoflurane-remifentanilanesthesia are all effective in inducing good anesthetic effect, maintaininghemodynamic stability and ensuring rapid recovery.There were no statisticalsignificance in side effects between the two groups.