Effects Of Three Different Methods Of General Anesthesia Combined With Controlled Hypotension Induced By Sodium Nitroprusside On Stress Response

ObjectiveTo observe the change of haemodynamics and plasma cortisol,angiotensinâ…¡made by three different methods of general anesthesia combined with controlled hypotension induced by sodium nitroprusside(SNP)in oral and maxillofacial plastic surgery patients.To compare the effects of different general anesthesia combined with controlled hypotension induced by sodium nitroprusside on stress response.MethodsThirty patients,ASAⅠ～Ⅱ,scheduled for oral and maxillofacial plastic surgery, were randomly divided into three groups:fentanyl-isoflurane group(groupâ… ,n=10); fentanyl-propofol-isoflurane group(groupâ…¡,n=10);remifentanil-propofol group (groupâ…¢,n=10).All of them were controlled hypotension induced by sodium nitroprusside.Mean arterial pressure(MAP)will be reduced about 30%,maintain more than 40 minutes.Before anesthesia(T₀);after anesthesia before hypotension(basic value,T₁);10 minutes(T₂),20 minutes(T₃),40 minutes(T₄)after hypotension;2 minutes(T₅),5 minutes(T₆),10 minutes(T₇),15 minutes(T₈),20 minutes(T₉)after stopped hypotension,record the date of systolic blood pressure(SBP),diastolic blood pressure(DBP),MAP and heart rate(HR),rate pressure product(RPP,SBP×HR), pulse oxygen saturation(SpO₂),end-tidal carbon dioxide partial pressure(P_ETCO₂). The 5ml samples of artery blood were collected at T₁,T₄,T₇.The levels of cortisol and angiotensinâ…¡in the plasma were measured by RIA. Results1.MAP:In groupâ…¢,MAP was significantly lower than that of groupâ… at T₅, T₇(P＜0.05).In groupâ…¢,MAP was significantly lower than that of groupâ… and groupâ…¡at T₆(P＜0.05).In groupâ… ,MAP was significantly increased than that of groupâ…¡at the T₅,T₆,T₇,T₈(P＜0.05).In groupâ…¡,MAP began to increase at T₆ and was still higher than base level at T₇,T₈(P＜0.05).2.HR:At T₂,T₃,T₄,HR was higher in all three groups compared with that at T₁(P＜0.05).But in the groupâ…¢,HR was significantly lower than that of groupâ… and groupâ…¡(P＜0.05).3.RPP:In groupâ… and groupâ…¡,RPP was significantly higher than the basis level at T₂,T₃,T₄,T₅,T₆,T₇(P＜0.05).In groupâ…¢,RPP was significantly lower than that of groupâ… and groupâ…¡at T₂,T₃,T₄(P＜0.05).In groupâ…¢,RPP was still significantly lower than that of groupâ… at T₅,T₆,T₇(P＜0.05).4.cortisol and angiotensinâ…¡:At T₄ and T₇,cortisol and angiotensinâ…¡were significantly increased compared with them at T₁(P＜0.05).In groupâ…¢,cortisol was significantly lower than that of groupâ… at T₄ and T₇(P＜0.05).In groupâ…¡,cortisol was significantly lower than that of groupâ… at the T₇(P＜0.05).In groupâ…¢, angiotensinâ…¡was significantly lower than that of groupâ… at T₇(P＜0.05).ConclusionDifferent anesthetic methods and anesthetic drugs had different effects on hemodynamic response and stress reaction in the perioperative period.TIVA with propofol-remifentanil appears to mitigate potentially hazardous haemodynamic responses from stressful stimuli and side effects of controlled hypotension induced by sodium nitroprusside.Regardless of the three different general anesthesia,harmful stimulus could not be completely blocked.The perioperative stress response was attenuated in patients anesthetized with propofol-remifentanil compared to anesthetized with isoflurane-fentanyl or propofol-isoflurane-fentanyl.