The Effect Of Combined Remifentanil And Propofol Anesthesia On Patients Undergoing Endoscopic Retrograde Cholangio Pancreatography

OBJECTIVE;To investigate the effect of combined remifentanil and propofol anesthesia on patients undergoing endoscopic retrograde cholangio pancreatography (ERCP).METHODS;109 patients undergoing ERCP with ASA physical status of gradeâ… andâ…¡were randomly allocated to 2 groups;those in group A were anesthetized with propofol while those in group B were anesthetized with remifentanil and propofol. Each group was divided into two subgroups;patients less than 65 years of age in group A were included in subgroup A_â… (n=25)and patients more than 65 years of age in group A were included in subgroup A_â…¡(n=27).In the same way,patients less than 65 in group B were included in subgroup B_â… (n=28)while those more than 65 were in subgroup B_â…¡(n=29).All patients were monitored with blood pressure(BP),electric cardiography(ECG)and pulse oxygen saturation(SPO₂)and were given oxygen with mask airway.Patients in subgroup A_â… and A_â…¡were induced with propofol 1.5mg/kg in about 2 minutes.Patients in subgroup B_â… and B_â…¡were induced with remifentanil 0.05 and 0.025 ug/kg/min,respectively in addition to the above propofol dosage.Then all the patients were maintained anesthesia with propofol infusion at a rate of about 500mg/h.The procedures began when the eyelash reflex was lost and the bispectral index(BIS)monitoring was about 50.The infusion rate of propofol was titrated to maintain the BIS monitoring at about 60 during operation. The blood pressure(BP),heart rate(HR),respiratory rate(RR),pulse oxygen saturation(SPO₂),rate of adverse effect(respiratory depression,BP descending,nausea and vomiting,cough and motion),dose ofpropofol and waking time were measured. Statistical analysis included analysis of independent simple T test and the Chi-squared test; p<0.05 was accepted statistically significant.RESULTS;1.There was significant difference in systolic blood pressure(SBP) between after induction and before induction in all subgroups(P<0.0001).There was significant difference in diasstolic blood pressure(DBP)between after induction and before induction in all subgroups(P<0.0001).There was no significant difference in the heart rate(HR)between after induction and before induction in all subgroups(P>0.05).2.respiratory rate(RR);There was significant difference between A and B group in before induction,after induction and consciousness recovered(P<0.0001).The mean respiratory rate of group A was higher than that of group B.There was no significant difference in pulse oxygen saturation(SPO₂)between different subgroups(P>0.05).3.the awakening time and the leaving time;There were significant difference between A and B group on the awakening time(P<0.0001),the awakening time of group A was longer than group B.There were significant difference between A and B group on the duration of stay in endoscope room(P<0.0001),the duration of stay in endoscope room of group A was longer than group B.4.Maintaining Dose of propofol;There were significant difference between A and B group in Maintaining Dose of propofol(P<0.0001).Maintaining Dose of propofol of group B was less than group A.5.Adverse effect;There were difference between A and B group(P<0.01).The effects of anesthesia group B was better than group A.Conclusion;Both combined Remifentanil and propofol anesthesia and simple propofol anesthesia can reduce stress reaction in ERCP.combined Remifentanil and propofol anesthesia has a shorter recovery time.With proper dosage of remifentaniland propofol,combined Remifentanil and propofol anesthesia can be safely used in elderly patients undergoing ERCP.