The Effects Of Propofol And Sevoflurane Anesthesia In Hemodynamics During Skin Incision

Objective To investigate the effects of sevoflurane,propofol,or sevoflurane combined with propofol anesthesia in hemodynamics when the depth of anesthesia was maintained at BIS 50 and to provide a more ideal anesthesia method.Methods Sixty ASAâ… orâ…¡patients undergoing elective upper abdominal surgery under general anesthesia were randomly allocated to one of three groups with 20 patients in each group.The patients were premedicated with intramuscular phenobarbital 0.1g and scopolamine 0.3mg.Then connected the patients with electrocardiogram(ECG),pulse oxygen saturation(SpO₂),BIS monitoring,and the line of radial artery catheterization,monitoring of direct arterial blood pressure(ABP).Three minutes after the Patient Quiet,anesthesia was induced with midazolam 0.05mg·kg^-1,fentanyl 2μg·kg^-1,groupâ… induced with sevoflurane and sevoflurane inhaled for maintenance;groupâ…¡induced with propofol and propofol injected for anesthesia maintenance;groupâ…¢induced with sevoflurane+ TCI propofol(1μg·ml^-1) and sevoflurane+ TCI propofol(1μg·ml^-1) for anesthesia maintenance.When BIS reduced to 75 inject vecuronium 0.12mg·kg^-1.Until the BIS fell to 55 below,tracheal intubation were began.The the concentration of sevoflurane inhalation inâ… ,â…¢group,and target-controlled propofol plasma concentration inâ…¡group,were adjust to the change of BIS value.BIS value was maintained at 45～55 after tracheal intubation during skin incision.1～2min before surgical incision, each group added fentanyl,2μg·kg^-1.BIS,ABP,HR,end—tidal sevflurane concentration and target plasma concentration of propofol were continuously monitored before anesthetic induction,before and after intubation,before and after skin incision 1 min,at 3min,5min,7min,9min after skin incision.Results There was no significant difference among three groups before induction of anesthesia. After tracheal intubation,HR of groupâ… andâ…¡was significantly higher than before(P＜0.05),but no significant changes was found among the three groups after skin incision.Before tracheal intubation, ABP of the three groups reached the lowest level,and was higher after tracheal intubation.SBP,MAP in groupâ…¡increased significantly greater than other groups(P＜0.05).After skin incision,ABP in three groups were increased.In groupâ…¢,SBP,MAP since 3min after skin incision,and DBP from 5min after skin incision had no significant change,while the other two groups had differences(P＜0.05).In the inter-group comparison,SBP,MAP since 1 min after skin incision,and DBP from 5min after skin incision were significantly different among the three group(P＜0.05).The blood pressure in Groupâ…¡was higher than groupâ… andâ…¢(P＜0.05).SBP in Groupâ… was lower than in groupâ…¢(P＜0.05),but also lower than the basic value(P＜0.05).Conclusion Sevoflurane-propofol intravenous inhalational anesthesia can leads to minor variation in hemodynamics than inhalation of sevoflurane or injection of propofol does,so it is better for anesthesia.