The Effects On Vasodilation In The Endoscopic Sinus Surgery With The Application Of Remifentanil Combining Sevoflurane And Propofol

Objective:To evaluate the effects of Remifentanil combined with Propofols and Sevoflurane respectively on changes of blood glucose during the periorperative period, in order to provide evidence for the judgment of the degree of surgical trauma and prognosis.Methods:According to ASA classification,40patients, grade Ⅰ～Ⅱ, who are in need of selective FESS surgeries are selected. Then divided into2groups with20patients in each group. Monitored by electrocardiograph and BIS, all patients established intravenous fluids channel in left foot dorsal vein. Anisodus tanguticus and500ml lactate linger solution is given to all the patients30minutes before the surgery. Oxygen is given by mask. Anesthesia induction:Then0.03mg/kg Midazolam is injected intravenously. Propofol,2mg/kg, Fentanyl citrate,4ug/kg, Atracurium,0.6mg/kg. Then endotracheal intubation and ventilation.Group A, Remifentanil and Sevoflurane group, Patients in this group are given Remifentanil which is diluted with saline(lmg to20ml) with continuous mini-pump infusion. Meanwhile,2～5%of Sevoflurane inhalation are given to patients to enable the mean arterial pressure in a range of60to70mmHg. Then, the inhaled concentration and the speed of the Remifentanil is adjusted according to blood pressure fluctuations to maintain consistent blood pressure. Group B, Remifentanil and Propofol group, The dosage pump of Remifentanil, Propofol and Atracurium is adjusted according to the state of anesthesia.Anesthesia state is monitored by Bispectral Inbeween dex within40～50. HR、MAP and the rate pressure product(RPP) are recorded before entering the operation room(T1), intubatation5min later(T2) and30min later(T3). Venous blood is collected at each time above mentioned. The blood glucose is tested by Rightestgm300made by Huaguang Biotech co. Limited. What’ more, the following information will be recorded:the surgery duration time, the amount of bleed loss, transfusion volume, reflex tachycardia and bradycardia, time of blood pressure turn to normal. All data will be analyzed statistically by software SPSS17.0Results:Comparing the data of gender, age, weight, surgery time and the amount of bleed loss and transfusion volume has no statistical significance(P>0.05). The blood glucose concentration is in line with the change of MAP and RPP at each time point. There is no statistics significance between groups (P>0.05). Patients’HR of two groups all become faster in T1, and five minutes and thirty minutes after controlled hypotension, the HR of two groups are faster than that of T1. The changes of MAP and RPP of two groups had no statistical significance. However, the difference was statistically significant at each time point (P<0.05). The changes of SBP, DBP were same in each time, there is statistical significance (P<0.05).The results showed that Remifentanil combined with Sevoflurane could blood pressure and which rapidly lead to anesthesia. Conclusion:The application of Remifentanil combined with Sevoflurane can reduce cardiovascular response during anesthesia. Compared with Remifentanil combined with Propofol, Remifentanil combined with Sevoflurane causes less side effect on hemodynamics. What’s more, there is less reliance on myocardial dysfunction as to anesthetic catheterization, extubation and perioperative management. This method also enables the surgical stress response under control.