The Impact Of Remifentanil And Fentanyl In Laparoscopic Surgery On Stress Response Of Human Body

Objective: Fentanyl in the control group, the observation of glucose and cortisol change during anesthesia induction and maintenance process with different dose of remifentanil, to evaluate the effectiveness and appropriate dosage of remifentanil on inhibit response to the surgical stress.Method: By ASA I - II ,thirty patients accepted selective LC operation were randomly divided into three groups(n=10 each).According to the fentanyl/remifentanil infusion rate,group I with fentanyl induction 2.5μg/kg and maintain 0.03μg/kg/min,group II with remifentanil induction 2μg/kg and maintain 0.2μg/kg/min,group III with remifentanil induction 2μg/kg and maintain 0.4μg/kg/min.Each group was induced with midazolam 0.1mg/kg, propofol 0.5 mg/kg, attacurium 0.8 mg/kg intravenous injection and tracheal intubation.SBP,DBP,MAP, HR were analyzed statistically at all time. BP and HR were recorded immediately before induction(T₀,baseline),at 30min after pneumoperitoneum(T₁),end of the surgery(T₂).Blood sample were taken at T_0-2 for monitor of glucose and determination of plasma concentration of cortisol. The data were analyzed.Result: 1.After 30 minutes of pneumoperitoneum, heart rate of group II and group III slowing down than the base value, but the difference was not statistically significant. Heart rate of group III decreased compared with group I (P <0.05). At the end of operation, heart rate of group II dropped no statistical significant. Heart rate of group III dropped more than group I (P<0.05). 2.After 30 minutes of pneumope -ritoneum, group I SBP increased by 8% and 9% rise in DBP; group II SBP down 1% DBP increased 6%; group III SBP decreased by 12% (p <0.05), DBP decreased 6%. After 30 minutes of pneumoperitoneum, SBP of group II,III are different with group I (P <0.05),group III DBP are different with group I (P <0.05). At the end of operation, three groups' blood pressure all dropped, SBP and DBP of group III are different with the base value and group I (P <0.05). 3. After 30 minutes of pneumope -ritoneum,Three groups' blood glucose all higher.Group II are different with base value(p <0.05). At the end of operation, group II, III compared with group I have significantly different(P <0.05).4.After 30 minutes of pneumoperitoneum, Group I and II's cortisol both higher. Group I are different with base value(p <0.05). Group II and III are different with Group I (p <0.05). At the end of operation, Group II slightly higher than the baseline, Group I and III lower than the baseline, there was no significant different.Conclusion: 1. Remifentanil inhibit effectively the stress response of operation. The effect of RF are stronger than fentanyl,and anesthesia process have more stable hemodynamics. 2. Group II and III both can meet the needs of surgery, there was no significant difference. So group II are more suitable dosage in terms of economics and hemodynamics perspective.