| BACKGROUND and OBJECTIVE:Starting in the early 1970s, along with the development of endoscopy for diagnostic and treatment technic, more and more gynecological disease have treated by laparoscope operation. At same time, The pneumoperitoneum , anesthesia and the patient positions required for laparoscopy induce pathophysiologic changes that were thought of by us gradually. But the majority of investigation and report about these changes was concentrated on respiratory, cardiovascular and endocrine system at present. The changes were of little concern on cerebral metabolism of energy and equilibrium of oxygen supply and demand.The aim of our experiment is to try to find the effects of gynecology laparoscopy together with enflurane, midazolam, and adjunct fentanyl anesthesia on regional cerebral circulation and metabolism by observing pathophysiologic changes during the operative procedure. All those can give experimental reference on the anesthesia and prevention of complication of nervous system about this kind of operation. METHODS:() General DataTwenty female patients (ASA class I or II) undergoing gynecology laparoscopy(with the uterine vessels dissected laparoscopically and with vaginal removal of the uterus) were included in study. Their mean age was 38 years (range 20-50). Patients with anticipated airway difficulties, neuromuscular disorders, metabolic disease, impaired renal or hepatic function, allergic reactions to any study drugs, history of asthma, or currently taking medications known to alter muscle transmission were excluded from the study.t) Anesthetic methodIn a prospective double-blinded controlled trial, twenty patients undergoing gynecology laparoscopy were divided into two groups. They were anesthetized either by enflurance(E group) or by midazolam(M group).ECG blood pressure by non invasive method and SpC2 were monitored by all the patients after transger to the operating theater. All patients were calmed by intravenous infusion of scopolamine 0.06mg/kg, midazolam 0.02mg/kg and innovar 0.04ml/kg. A radial artery catheter and internal jugular paracentesis catheter for hemodynamic measurements and for blood sampling were introduced under local anesthesia with lidocaine. Blood samples were taken simultaneously from the radial arterial and the internal jugular bulb.Anesthesia was induced with enflurane 1.5MAC, fentanyl 2 g/kg, vecuronium 0.1mg/kg(Group E) or midazolam 0.3 mg/kg, fentanyl 2 g/kg, vecuronium 0.1mg/kg(Group M). Then the Endotracheal tube is inserted. General anesthesia was maintained with enflurane 0.65MAC , fentanyl 0.06 g 'kg"1 Tnin"1 and with incremental doses of vecuronium 0.05mg/kg when needed(Group E) or with midazolam 1.50 g ?kg"1 ?min"1, fentanyl 0.06 g ?kgl ?min"1 and with incremental doses of vecuronium 0.05mg/kg when needed(Group M). During anesthesia the patients' breath of two groups were controlled by anesthesia apparatus(SIEMENS-SC7000 Solna, Sweden) and10the frequency was kept at 14 breaths/min. The tidal volume was 7ml/kg. The inspired/expired odds was 1 '- 2. An intravenous infusion of 0.9% NaCl solution was at the rate of 0.05~0.1ml ?kg~' ?mhT1. When hemodynamic repercussions of anesthesia were stable, pneumoperitoneum machine (Olympus) created pneumoperitoneum for laparoscopy by intraperitoneal insufflation of CC2, and the intraabdominal pressure(IAP) was maintained automatically at the desired level(1.8~2.0kPa). The position turned to head-down position 30~45?(trendelenburg position).() Investigation methodBlood samples were taken with the patient supine in her bed. Sample were collected at five time points, prior to anesthesia(A), prior to pneumoperitoneum(B), 10 minutes after pneumoperitoneum(C), 20 minutes after pneumoperitoneum(D), 60 minutes after pneumoperitoneum(E). Blood was simultaneously withdrawn via the line of left radical artery and the internal jugular vein respectively. The changes have been observed about the partial pressure of arterial carbondioxide(PaCO2) the internal jugular venous partial pressure of oxyg...
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