| Objective: To observe the dynamic change of the MMSE score and serumcortisol concentrations before and after surgery, to investigate the effect of flumazenilon postoperative cognitive function after sevoflurane anesthesia.Methods: Sixty ASA I or II patients aged40-60years old undergoinglaparoscopic hysterectomy surgery under general anesthesia were randomized equallydivided into three groups with20cases each: F1group(receive flumazenil0.5mgafter sevoflurane/remifentanil anesthesia),C group(receive an equal volume of normalsaline after sevoflurane/remifentanil anesthesia), F2group(receive flumazenil0.5mgafter propofol/remifentanil anesthesia). No perimedincation were given in allpatients.Anesthesia was induced with fentanyl3-5ug/kg, propofol1.5-2.0mg/kg andvecuronium0.08-0.12mg/kg according to their general conditions, group F1and Cmaintained with sevoflurane/remifentani while group F2with propofol/remifentani.Maintain Entropy index in the range of40-50by adjusting sevoflurane inhaledconcentration and the infused rate of propofol and remifentani during surgery.4mgondansetron was intravenous injected30minutes before the end of surgery, Thesevoflurane and propofol were terminated when skin was closed, then start patientcontrol intravenous analgesia (PICA). When end-expired sevoflurane concentrationdecreased to0.45％～0.50％or patients recover autonomous respiration, the testdrug was given. Cognitive functione was assessed by the Mini Mental StateExamination examination (MMSE) at five time points: baseline and1hour,12hours,24hours,48hours after surgery respectively, by the same tester. Observing therecovery time to eye-opening, command-movement and orientation, valuing thescores of Steward at different time points after extubation respectively. Concentrationof plasma cortisol was measured in the preoperative and postoperation. Spss18.0software was used for statistical analyses. Data were presented as the mean±standarderror of the mean (SEM). Statistical significance of difference between means wasevaluated by t-test and P values less than0.05were considered statistical significance. Results:1. General condition: Patients in the three groups were not significant differencein age, weight, years of education and time of anaesthesia (P>0.05).2. Times of recovery: The times from sevoflurane termination to eye-openingwithout statistical significance(P>0.05). There were significant difference in therecovery times to orientation when group F1and F2compare with group C(P <0.05).The times to command-movement of group F2were shorter than group C,thedifference was statistically significant (P <0.05)3. The scores of Steward: The scores of Steward increased successively at all thetimes points in all three group,especially in group C,when S3compare with S1(P<0.05).There were higher scores in group F1and F2at S1and S2when comparewithe group C (P <0.05).4. MMSE: All patients’MMSE score lower compared with preoperative, F1group performanced in the postoperative1h,12h, group C showed postoperativeMMSE score were lower in each time point, while group F2presented at1hour aftersurgery. What’s more, MMSE score significantly lower in group C at each time pointlower than F1,F2group(P <0.05).5. Plasma cortisol: The concentration of plasma cortisol increased after surgeryin all three group,while the changes in group F1and C had statistically significant (P<0.05). What is more, the concentration of plasma cortisol in group C weresignificantly higher than group F1and F2(P <0.05).Conclusion:Under this experimental condition, sevoflurane show a reversible impairment onshort-term cognitive function, while administration of a single dose of0.5mgflumazenil to healthy unpremedicated patients at the end of sevoflurane/remifentanilanaesthesia results in earlier emergence from anaesthesia and significantly expeditesrecovery, as well as to propofol/remifentanil anaesthesia.This could redefine the roleof flumazenil in general anaesthesia, which may be related to relieve stress reaction. |
PDF Full Text Request