The Effect Of Two Anesthesia Methods On Stress Reaction In The Elderly Patients Undergoing Lapsroscopic Cholecystectomy

Objective To evaluate the effect of target-controlled infusion (TCI) of propofol orsevoflurane inhalation anesthesia on stress reaction in the elderly patients undergoinglapsroscopic cholecystectomy. Methods Fifty ASAâ… orâ…¡patients aged 60～70yundergoing elective laparoscopic cholecystectomy were randomly divided into twogroups: propofol group (n=25, P group) and sevoflurane group (n=25, S group). Afterrapid induction all patients were intubated with a tube. In P group anesthesia wasmaintained with propofol given by TCI and continuous infusion of remifentanil0.3ug·kg^-1·min^-1; in S group anesthesia was maintained with 1～3ï¼…end-tidal concentrationof sevoflurane and continuous infusion of remifentanil 0.3ug·kg^-1·min^-1. BIS wasmaintained at 40～60 by adjustment of target-effect propofol concentration or sevofluraneinspired concentration. Hemodynamic variables including non-invasive blood pressure(NiBP), heart rate (HR), electrocardiogram (ECG), saturation of blood oxygen (SpO₂),cardiac output (CO), cardiac index(CI) and systemic vascular resistance(SVR) werecontinuously measured through-out anesthesia. All patients were measured cortisol (Cor),norepinepherine (NE), epinephrine (E), cortisol (Cor) and interleukin-6 (IL-6)at 10minbefore anaesthesia, 10min after the anaesthesia, 30min and 60min afterpneumoperitoneum and 30min after operation. Results (1) There were no significantdifferences between two groups in age, sex, weight, height, anesthesia time and so on(P＞0.05). (2) HR, SBP, MAP and SVR were significant decreased at 10min after theanaesthesia compared to 10min before anaesthesia and increased at 30min and 60minafter pneumoperitoneum and 30min after operation compared to 10min after theanaesthesia in both groups (P＜0.05), but there were no significant differences in DBP,CO and CI at various time points (P＞0.05). There were no significant differences betweentwo groups in hemodynamic parameters at various time points (P＞0.05). (3) NE issignificant decreased at every points at 10min after the anaesthesia compared to10min before anaesthesia in both groups (P＜0.01). NE is significant decreased at everypoints at 10min after the anaesthesia in S groups compared with P groups at the sametime points (P＜0.01).(4) E is significant decreased at every time points after the anaesthesia compared to 10min before anaesthesia in two groups (P＜0.01). E issignificant lower at all points except 10min before anaesthesia in S groups than in Pgroups(P＜0.01). (5) Cortisol is significant increased at 60min after pneumoperitoneumand 30min after operation compared to before 10min anaesthesia in two groups (P＜0.01).Cortisol is lower at same time points in S groups than in P groups (P＜0.01). (6) IL-6is significant increased at 60min after pneumoperitoneum and 30min after operationcompared to 10min before anaesthesia in P groups (P＜0.01). IL-6 is significantincreased at 30min after operation compared to before anaesthesia 10min in S groups(P＜0.01). IL-6 is significant lower at all points except 10min before anaesthesia in Sgroups than in P groups (P＜0.01). Conclusions The effect of target-controlledinfusion of propofol on hemodynamic in the elderly patients undergoing lapsroscopiccholecystectomy in a similar degree to sevoflurane inhalation anesthesia. Sevoflurane wasmore intensity in inhibiting stress reaction than propofol.