The Feasibility And Hemodynamic Effect To Remifentanil Combined Anesthesia Of Different Dose Snd Method On Laparoscope Surgery Of Gynecology

Objective To investigate the best dose,method and hemodynamic effects of remifentanil combined anesthesia on laparoscope surgery in gynecology by observed the effective and hemodynamic respondence on remifentanil anesthesia with different dose and combined method.Methods Seventy-five ASA physical statusⅠ-Ⅱpatients who had undergone laparoscope surgery of gynecology to apply anesthesia with tracheal intubation were divided into five groups randomly.Every group involved 15 patients.After administered with midazolam 0.05mg/kg,propofol 2mg/kg and vecuronium 0.1mg/kg and remifentanil 1μg/kg to induction in turn,all patients were tracheal intubated.The groupⅠ-Ⅳwas holo-intravenous anesthetize with different doses of remifentanil and propofol 100μg·kg^-1·min^-1by two micro-pumps.The dose of remifentanil in four groups was 0.2μg·kg^-1·min^-1, 0.3μg·kg^-1min^-1,0.4μg·kg^-1·min^-1,0.5μg·kg^-1·min^-1respectively. The groupⅤwas intravenous-inhalation combined anesthetize with remifentanil 0.4μg·kg^-1·min^-1and 0.8%～1.0%isoflurane inhalated to maintain.The blood pressure and basal heart rate,after induction,tracheal intubating and 3 minutes within tracheal intubated and the intubation condition were observed.The hemodynamic changes to the different surgical stimulation,the condition of resuscitation and the adverse reactions after surgery were also observed.Results The blood pressure and heart rate after induction were decreased obviously(p＜0.01).The blood pressure in exposing glottis was higher distinctly compared with that after induction(p＜0.05).And the heart rate in tracheal intubating was also obviously higher contrasted with that after induction(p＜0.05).All patients of the tracheal intubation were smooth.The tracheal intubating condition in 72 patients was satisfied(96.0%).During the maintenance,the hemodynamic changes to inserting Procar in groupⅠwas the most obviously,was different distinctly compared with that of base and before incision(p＜0.05).And that of inserting Procar and flushing abdominal cavity in groupⅠand groupⅡwas obviously larger than that of the base and before incision(p＜0.05).The distinction between the hemodynamic respondence of groupⅢ-Ⅴand that of groupⅠwas different in inserting Procar and flushing abdominal cavity(p＜0.05).The blood pressure and heart rate in groupⅣwas lower than that of other groups,used more doses of ehedrine and atropine, more adverse reactions after surgery,while the fluctuation of MAP and HR in groupⅠwas larger.The extubated time in groupⅤwas longer than other group's.Conclusion Aministered with mdazolam 0.05mg/kg,propofol 2mg/kg, vecuronium 0.1mg/kg and remifentanil 1μg/kg could provide acceptable tracheal intubating conditions and inhibites the excessively hemodynamic changes.The dose of remifentanil 0.3 or 0.4μg·kg^-1·min^-1and propofol 100μg·kg^-1·min^-1combined anesthesia on laparoscope surgery could come to good effect and stable hemodynamics and low adverse reaction.The incidence of hypotension and bradycardia in remifentanil and propofol combined anesthesia was much higher.The combined anesthesia of remifentanil and isoflurane was an ideal method on laparoscope surgery in gynecology too.