Effects Of Nicardipine On The Respiratory And Circulatory Stability During Laparoscopic Cholecystectomy

Objective: The aims of the study were to investigate the effectiveness andfeasibility of nicardipine hydrochloride pretreatment on the stability of circulatory andrespiratory parameters in patients undergoing laparoscopic cholecystectomy, in order toprovide the basis for clinical practices.Methods:32patients undergoing selective laparoscopic cholecystectomy, aged28-78, ASA I-II (13men and19women,23suffering gall stone and9sufferinggallbladder polyps), were enrolled in the experiment. All patients did not havecardiopathy, hypertension, diabetes mellitus, trachitis and asthma. Exclusion criteriawere calcium channel blocker intake24hours before operation and tachycardia orbradycardia, acute cerebral hemorrhage, hepatic or renal dysfunction, hypotension andglaucoma.The patients were randomly assigned to two groups, group I (control group),group II (experimental group). General anesthesia was firstly induced with intravenousinjection midazolam0.03mg/kg,fentanyl5/kg, etomidate0.3mg/kg and cisatracurium0.2mg/kg. After intubation was performed, Datex Ohmeda Aestiva/5-7100anestheticapparatus was connected for mechanical ventilation, the tidal volume was set10ml/kg,respiration rate13/min and I:E1:1.5. Propofol was used for anesthesia maintain. a doseof10/kg nicardipine was administered intravenously2minute before skin incision aspretreatment (the medication was injected continuously for90seconds). Following datawere documented: heart rate (HR), the systolic blood pressure (SBP), the diastolicpressure (DBP), stroke volume (SV), cardiac output (CO), acceleration index (ACI),thoracic fluid content (TFC), systemic vascular resistance (SVR) in a series of time, i.e.at the time of entering operation room (T1), after intubation (T2), before skin incision(T3), after skin incision (T4), at the time of pneumoperitoneum (T5),5minutes after pneumoperitoneum (T6),10minutes after pneumoperitoneum (T7),15minutes afterpneumoperitoneum (T8) and Peak airway pressure (Ppeak) in the following time: T2、T4、T5、T6、T7、T8.Result: The levels of SBP, DBP, acceleration index, SVR and myocardial oxygenconsumption were higher in group I than in group II from T5to T8, and the differenceswere statistically significant (P<0.05). Levels of SV and TFC were significantly lowerin both groups from T6to T8than initial T1levels (P<0.05respectively). However, thedifferences between two groups were not significant at same time point. The levels ofSBP, SVR and myocardial oxygen consumption were higher than their initial T1valueat both T6and T7time points, and the differences were significant statistically (P<0.05,respectively). The levels of Ppeak were not significant changed in same group fromT5-T8, but were higher than those from T1to T4, the differences were significantstatistically (P<0.01). In contrast, the differences between I group and II group were notstatistically significant at same time point.Conclusion: Pneumoperitoneum during Laparoscopic Cholecystectomy lead to anincrease in blood pressure or heart rate and an enhancement in SVR. Although the heartrate was slightly increased when nicardipine was pretreated with a dose of10ug/kgintravenously, the haemodynamical parameters were improved, the myocardial oxygenconsumption was decreased, the effects could have cardiac protection. Howevernicardipine pretreatment does not exert effect on the airway parameters.