Effects Of Pneumodynamics On Propofol-remifentanil And Sevoflurane-remifentanil Anesthesia Druing The Procedure Of Pneumoperitoneum

Objective To explore the effects of remifentanil combined with propofol givenby target-controlled infusion or sevoflurane anesthesia on pneumodynamics in patientswith the procedure of pneumoperitoneum.Methods Forty ASA I～II,20～60years old, weighted45～65kg patients, whowere accepted general anesthesia undergoing elective gynecological laparoscopicoperation （surgical procedures of relatively long duration two hours）, were randomlydivided into2groups（n=20，each）. Group P underwent intravenous TCI of propofoland remifentanil（n=20）and group S underwent remifentanil combined withsevoflurane anesthesia（n=20）. Intraoperative setting tidal volume8～10ml/kg,frequency12times/min, inspiratory/expiratory1:1.5, O₂/Air inhaled （O₂and Air flowwere0.5L/min, FiO₂60%），SpO₂fluctuate in98～100%,PETCO₂was maintained at35～45mmHg. Group P were maintained with TCI of propofol （Cp=3ug/m1） andremifentanil infusion of constant speed. Group S continuously inhaled sevofluranewhich maintained at2%～3%and remifentanil infusion of constantspeed.Intraoperative maintain entropy between40and60.Every time two groups ofpatients′variables were recorded such as tidal volume（VT）, ent-tidal CO₂pressure（PETCO₂）, airway pressure（Paw），peak of airway pressure（Ppeak），plat of airwaypressure（Pplat），lung-thorax compliance（Compl） and alveolar dynamic compliance（Cdyn）at four certain intervals:5min after intubation （T1）,15min （T₂） and60min（T3） after pneumoperitoneumï¼›5min after reversal of pneumoperitoneum（T4）. At thesame time，extract the arterial blood for blood gas analysis and calculatealveolar-arterial oxygen tension difference（PA-aDO₂） along with QS/QT.Results Interclass: Compared with pre-pneumoperitoneum and5min afterreversal of pneumoperitoneum VT, Compl, Cdyn and the value of pH were lower andCO₂pressure，Paw，QS/QT were much higher during pneumoperitoneum（p<0.05）.Compared with pre-pneumoperitoneum, VT, Compl,Cdyn，Paw andQS/QT were stable, while CO₂pressure was higher and the value of pH was lower after reversal of pneumoperitoneum（p<0.05）. Intraclass：Pre-pneumoperitoneum: therewere not significant differences between two groups in each monitored item. Duringpneumoperitoneum: Compl: group P＜group S，Paw：group P＞group S, while therewere not significant differences in VT,Cdyn，the value of pH，CO₂pressure andQS/QT.Conclusion During the procedure of gynecological laparoscopic operation,there are obvious effects on patients′function of respiration and circulation sincethe pneumoperitoneum and position. Compared with intravenous propofol，sevoflurane-remifentanil has a more positive meaning in improving pneumodynamics.