Effect Of Sevoflurane On Haemodynamics And Respiratory Mechanics Undergoing Retroperitoneal Laparoscopy

Objective:To explore the effect of sevoflurane on haemodynamics and respiratory mechanics in patients undergoing retroperitoneal laparoscopy.Methods:Using randomized controlled methods divided 80 patients of retroperitoneal laparoscopy into sevoflurane-remifentani group(SR) and propofol-remifentani group(PR),each group of 40 cases. Slowly intravenous injection of fentanyl 3 ~ 5μg/kg,Cis-atracurium0.2mg/kg, etomidate 0.15~0.30mg/kg anesthesia induction, intraoperative SR group keep out at the end of the 1.3 MAC sevoflurane, PR group maintain propofol 6~10mg·kg-1·h-1, two groups are pumping remifentaini 7 ~ 12μg·kg-1·h-1, the BIS was maintained between 40 ~ 50, timely supplementary cis-atracurium 0.05mg/kg. Mean arterial blood Pressure(MAP), Heart rate(HR), Peak of airway pressure(Ppeak), dynamic compliance(Cdyn)and End-tidal CO2 pressure(PETCO2) were monitored and recorded5 min after inducti on(T1), Lateral position and pre-pneumoperitoneum(T2), 15min(T3),30min(T4) and 45min(T5) after pneumoperitoneum, 10 min after reversal of pneumoperitoneum(T6). Pa CO2(Partial pressure of carbon dioxide in artery), PH, Pa O2(arterial partial pressure of oxygen), OI(oxygenation index), RI(respiratory index),PA-a DO2(alveolar-arterial oxygen tension difference), QS/QT(Intra Pulmonary shunt rate)and ET-1(Endothelin-1) were monitored and recorded at T1、T4、T6.Result:The SR group compare with PR group, MAP and HR increased obviously at T4(P<0.05); At T2 compare with T1 in SR and PR of groups, The Ppeak and PETCO2 were significantly higher, Cdyn was Significantly lower(P<0.05); The Ppeak and PETCO2 at T3,T4, T5 in group SR was Significantly lower than that at corresponding time point in group PR; The Cdyn at T3, T4, T5 in group SR was Significantly higher than that at corresponding time point in group PR, The other each time point is similar. Between SR and PR groups, it had not statistical siginficance(P > 0.05); PETCO2 each time point compared differences between the two groups had not statistical significance(P>0.05); Pa CO2、PA-a PO2、RI、QS/QT:The SR and PR group in T4 than T1 increassed slightiy(P<0.05), PR and SR group,each time point compared differences had not statistical significance(P>0.05);PH、OI:The SR and PR group at T4, T6 compare with T1 Significantly lower. The PR group compare with SR group, each time point compared differences had not statistical significance(P>0.05);plasma ET-1 at T4, T6 in group SR was Significantly lower than that at corresponding time point in group PR(P<0.05).Conclusion:In terms of hemodynamics, sevoflurane compared with propofol, which can reduce the release of ET-1 and which has certain protective effect to the endothelial cells, the impact on the MAP, HR is consistent; In terms of respiratory mechanics, sevoflurane can reduce the impact of Cdyn, Ppeak undergoing retroperitoneal laparoscopy.