Sevoflurane Remifentanil Is Used For Theclinicalobservation Of Gynecological Laparoscopic Surgery

Objective:Two kinds of anesthesia have been reported at home and abroad,but there are few reports on the evaluation of the dosage system of anesthetic drugs in intraoperative anesthesia.This study by observing the sevoflurane more-rui fentanyl static absorption compound anesthesia with propofol-fentanyl by using the two anesthesia scheme intravenous anesthesia in gynecologic laparoscopic surgery anesthesia drugs,the dosage of anesthetic effect,postoperative recovery quality and economic benefit.To fully discuss the static absorption compound anesthesia and all by intravenous anesthesia both general anesthesia scheme to of anesthesia in gynecologic laparoscopic surgery and gynecologic laparoscopic surgery for the future of clinical anesthesia and provide further reference and guidance.Methods:Selection of yanan university hospital in October 2016 to October 2017 gynecological laparoscopic elective surgery(operation time about 2.5 hours)of 80 cases of patients,ASA class I ~ II,were randomly divided into 2 groups: 40 cases in each group,propofol group,respectively(PR)and sevoflurane group(SR).Open upper limb vein after patients into the operating room,to routine ecg monitor,and monitoring of anesthetic depth(BIS),breathe out CO2 partial pressure at the end of the PET(CO2),the concentration of inhalation anesthetics,muscle relaxant(TOF)values.Before anesthesia induction,preoperative drug atropine 0.5mg,diazocine 0.1mg/kg.Anesthesia induction of two groups were given midazolam 0.05 mg/kg,rui fentanyl mu 0.2 g/kg/min,and then PR group was given propofol 1 ~ 2 mg/kg to eyelash reflex disappears,patients with TOF-Wateh for calibration,stable after 5 min,o give cis library according to 0.15 mg/kg,with TOF T1 maximum inhibition level began to endotracheal intubation.In SR group,the patients first inhaled 6L/min oxygen and 8% concentration of sevoflurane,etc.After the patients’ eyelash reflection disappeared,the oxygen flow was reduced to 1L/min and sevoflurane concentration decreased to 4%,followed by the same as the PR group.In the two groups of intraoperative anesthetic maintenance,the PR group sustained pump injection of propofol 2~5mg/kg-1·h-1 and rifentanyl 0.1-0.3,and g·kg-1·min-1,while the SR group continued to inhale the same dose of remifentanil as 1.0MAC~2.0MAC flurane and pump injection and PR group.After intubation,the VT of the anesthesia machine is 6~8ml/kg,f is 10~14 times /min,I:E is 1:1.5.By changing the inhalation concentration of sevoflurane and the continuous pumping speed of propofol at any time,the BIS value was controlled between 40 and 60.By adjusting the respiratory parameters: the breath frequency,tidal volume,call absorption ratio control breath at the end of the co2 partial pressure maintain between 35 and 45 mm Hg,at any time according to the change of blood pressure,heart rate adjustment of fentanyl injection pump speed.According to the value of muscle pine(TOF),the dosage of cis-quamonium was adjusted.Muscle relaxants and sedatives are expected to stop before 30 minutes of surgery.The pump injection of propofol or inhalation of sevoflurane after the release of pneumoperitoneum and the infusion of remifentanil.To observe and record the dosage of the anesthetic time,the unit time of muscle relaxant(cis)and analgesic(remifentanil)in the two groups.To observe and record the time of the two groups of patients from the closure of sevoflurane to the waking period,to the waking period of the waking period,and to the time when the endotracheal tube was removed during the waking period;Observe and record home when two groups of patients(T0 baseline),insert the endotracheal tube(T1),5 min after insert the endotracheal guide(T2),when the pneumoperitoneum inflatable(T3),pneumoperitoneum inflatable after 5 min(T4),sewing leather(T5),pull out at the end of the endotracheal tube(T6),pulling the endotracheal tube after 5 min(T7 has)pulse oxygen saturation(SPO2),systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),PETCO2 and BIS value;To observe and record the number of postoperative adverse reactions including cough,vomiting,chest tightness,dizziness,irritability and intraoperative knowledge in two groups.To observe and record the anal exhaust time and defecation time after operation of two groups of patients;Observation and record of 10 min sedation and restlessness score(RSAS)and pain score(VAS)were recorded in two groups of patients.Observe and record the length of hospital stay and total hospital stay after operation.Results:1.There was no statistically significant difference between the two groups in age,height,weight and duration of anesthesia(P BBB 0.0.5).2.Patients in SR group were significantly reduced in the dose of analgesics(remifentanil)and muscle relaxant(cis)in the group of patients,with statistically significant difference between the two groups(P<0.5).3.The SR group of patients from sevoflurane can close to extubation period of time,breathing to extubation period independent open time,to wipe out the endotracheal tube extubation time patients have a PR group was obviously shortened,differences between the two groups was statistically significant(P < 0.05).4.Two groups of patients when home based value(T0),insert the endotracheal tube(T1),5 min after insert the endotracheal guide(T2),when the pneumoperitoneum inflatable(T3),pneumoperitoneum inflatable after 5 min(T4),sewing leather(T5),pull out at the end of the endotracheal tube(T6),pulling the endotracheal tube(T7 has)after 5 min of SBP,5 min after endotracheal guide is inserted in the two groups(T2),when the pneumoperitoneum inflatable(T3),pneumoperitoneum inflatable after 5 min(T4),systolic blood pressure difference was statistically significant(P < 0.05),more than point the comparison of two groups of patients with SBP were not(P > 0.05).The SBP and DBP in the PR group were significantly lower than T0 at the three time points of T2,T3 and T4,while the SBP T2,T3,T4 and T0 in the SR group showed a decreasing trend,but there was no statistical significance.Two groups of patients.5.There was no statistically significant difference between the two groups(P BBB 0.05),after the patients were treated with cough,vomiting,chest tightness,dizziness,irritability,and intraoperative knowledge of postoperative adverse reactions.6.Two groups of patients with postoperative anal exhaust time and defecation time compared between groups,the SR group of patients with postoperative exhaust time and more PR patients to shorten defecation time,there is a significant difference between the two groups were statistically significant(P < 0.05).7.There was no statistically significant difference between the two groups(RSAS)and pain score(VAS)between the two groups(P < 0.05).8.There was no statistically significant difference between the two groups in postoperative hospital stay and total hospital stay(P < 0.05).Conclusion:Both anesthesia and intravenous anesthesia can achieve satisfactory anesthetic effect and good postoperative recovery quality.Although the two anesthesia methods are suitable for general anesthesia induction and maintenance of two anesthesia surgery program can finish all quick awakening and two kinds of anesthetic solution less incidence of postoperative adverse reactions,but sevoflurane group per unit time analgesic and the amount of muscle relaxant decreased significantly in the propofol group and quicker recovery of gastrointestinal function.The overall evaluation of the combined anaesthesia combined with remifentanil combined with remifentanil combined with gynecological laparoscopic surgery was better than that of propofol combined with remifentanil.