Effects Of Propofol Target-controlled Infusion And Inhalation Desflurane During Gynecological Laparoscopic Operation In The Elderly

Objective:To observe the effects of anesthesia maintenance combined propofol target-controlled infusion(TCI)with inhalation desflurane during gynecological laparoscopic operation in the elderly.Methods:90 patients scheduled for gynecological laparoscopic surgery were randomly allocated into three groups of 30 each.In the propofol maintenance group(Group P),the target plasma propofol concentration was set at 3 ~ 4 ?g/ml.In the propofol combined with desflurane maintenance group(Group PD),patients received desflurane at end-tidal concentration of 2%~3% on the basis of Group P.In the desflurane maintenance group(Group D),the end-tidal concentration of desflurane was set at 5%~8%.Following indexes were recorded: haemodynamics at each time point of pre-intubation(T0),spontaneous intubation(T1),5 min post-intubation(T2),spontaneous CO2 insufflation(T3),5 ~ 25 min post-CO2 insufflation(T4 ~ T6),removing endotracheal tube(T7),5 min post-extubation(T8);total antioxidant capacity(T-AOC),superoxide dismutase(SOD),glutathione peroxidase(GSH-Px),malonaldehyde(MDA),vitamin E(VE)were measured at T0 and T8.;the time of returning to spontaneous ventilation,eye opening,tracheal extubation,staying in PACU;peri-operative bleeding,operation time,postoperative nausea and vomiting(PONV),emergence agitation(EA).Results:1.General information There was no significant in general information and operation time(P?0.05).2.Perioperative hemodynamic changes The MAP at T3,T4,T5 and the HR at T3 in Group PD were lower than those in Group P(P?0.05).There were no severe hemodynamic changes in the three groups.3.Oxidative stress The T-AOC value of Group P at T8 was significant higher than T0(P?0.05);The T-AOC and vitamin E values of Group D at T8 were significant lower than T0(P?0.05).Comparison among groups: The T-AOC value of Group P at T8 was the highest among the three groups(P?0.05).4.Early recovery The time of eye opening and tracheal extubation in Group PD was also less than Group P(P?0.05).5.PONV and EA The early incidence of PONV in Group D(26.67%)was significant higher than those in Group PD and Group P(3.33%)(P?0.05).While there were no differences about the incidences of PONV in ward and emergence agitation among three groups(P>0.05).Conclusion:It can be safe in gynecological laparoscopic operation in the elderly with three anesthetic methods.The anesthesia maintenance of combining propofol TCI with inhalation desflurane has stable haemodynamics,little influence on perioperative oxidative stress,early postoperative recovery and the low incidence of PONV.