Optimization Scheme Of Fentanyl In Gynecologica Laparoscopic Operation

ObjectiveTo observe the clinical effect of different doses of fentanyl combined with propofol inperioperation period, the optimal dosage regimen of fentanyl was investigated in patientsundergoing gynecological laparoscopic operation.MethodsSixty ASA physical status I patients with body mass index18～25kg/m2scheduledfor laparoscopic ovarian cyst divesting operation were randomly divided into three groupsaccording to the dose of fentanyl at induction. The dose of fentanyl at induction in group A,B, C was4μg/kg,6μg/kg,8μg/kg respectively. Induction of anesthesia was begun withpropofol3μg/ml, the dose of fentanyl at induction were given at the same time. As soonas consciousness disappeared, vecuronium0.1mg/kg was given. Three min later, trachealintubation was performed. After intubation, target controlled concentration of propofol wasadjusted to2.5μg/ml which was remain unchanged during operation. All patients receivedadditional fentanyl4μg/kg before operation, vecuronium0.02～0.06mg/kg was injectedat intervals of30min. Patients who had a increase in MAP or HR exceeding20％of thebaseline value was treated with intravenous fentanyl1μg/kg. Metaraminol0.2mg wasgiven in patients with hypoteasion (MAP <80％of the baseline). Atropine sulfate0.5mgwas given when HR <50bpm. The values of MAP, HR and BIS were recorded at thefollowing time points: the baseline value (T0), the lowest value during induction (T1), thehighest value within5min after intubation (T2), the highest value within5min afteroperation beginning (T3), the highest value within5min after abdominal exploration (T4), the highest value of5min after extubation (T5). The time of eye opening and extubation were recorded. The use of fentanyl, propofol and vasoactive drugs during operation were recorded. The respiratory frequency, Prince-Henry pain scores, Steward scores and Riker agitation scores, the cases requiring analgesic rescue with naloxone were recorded. Postoperayive adverse events such as nausea and vomiting, respiratory depression and intraoperative awareness were recorded.Results(1) Compared with the baseline, MAP and HR decreased at T1and increased at T5in all groups, but there were no statistical significance between the three groups (P>0.05). Compared with the baseline at To, HR increased in group A and decreased in group C at T2, the changes of HR were statistically significant (P<0.05); MAP in group B and C was higher than that in group A (P<0.05). MAP and HR in group B and C were lower than that at To and in group A (P<0.05)., SBP and HR in group C were lower than that in group B (P<0.05). Compared with the baseline at T0, MAP in group A and group B increased at T4, MAP and HR in groups B and C were lower than that in group A, the changes showed statistically significant (P<0.05).(2) BIS after induction were significantly lower than that at T0in three groups (P<0.05), while there was no statistically significance between three groups at T5(P>0.05). BIS in group B and C was lower than that in group A at T1, T2, T3, T4(P<0.05).BIS in group C was lower than that in group B at T1and T2(P<0.05).(3) The dosage of propofol and atropine showed no significance (P>0.05). The total doses of fentanyl in group B and C group were larger than that in group A (P<0.05), the total doses of fentanyl in group C was larger than that in group B (P<0.05). The cases requiring rescue with fentanyl in group B and C group were fewer than that in group A (P <0.05). Compared with the group A and B, the cases of adding metaraminol in group C increased (P<0.05).(4) There were no difference between three groups about the time of eyes opening, extubation time and the pain scores (P>0.05). The incidence of nausea and vomiting ingroup A was not different from that in group B and C (P>0.05). Compared with group A,postoperative restlessness scores and respiratory frequency in group B and C decreased (P<0.05). Steward scores in group C were lower than that in group B (P <0.05), all patientsunderwent consciousness during operation.ConclusionsThe perioperative effect in young people undergoing gynecological laparoscopicoperation is observed in this study, which combines target controlled infusion of propofolwith different dose of fentanyl. The dose of fentanyl at induction is4μg/kg,6μg/kg,8μg/kg respectively, target control concentration of propofol induced is3μg/kg and is2.5μg/ml intraoperative. Fentanyl4μg/kg induced can not effectively inhibit the increase ofHR and BIS after intubation, the cases of adding fentanyl intraoperative and the scores ofpostoperative patients restless significantly increase. Fentanyl8μg/kg induced can inhibitthe intubation reaction effectively, blood pressure and HR in this group is low, but thenumber of times about the use of metaraminol anesthesia increase, it is easy to causeexcessive sedation after operation. It is the optimal scheme of gynecologic laparoscopicoperation that using fentanyl6μg/kg at induction. Patients can quickly regainedconsciousness after the surgery, with the stable hemodynamic during the operation.