| ObjectiveFentanyl in the control group,the observation of haemodynamic effects,glucose and cortisol change during anesthesia induction and maintence process,to evaluate the clinical effect and safety of butorphanol induced and maintained general anesthesia in seletive laparoscopic surgery.Method44 women patients(20 to 45 years old,ASAI～Ⅱ) undergoing selective laparoscopic surgery were randomly divided into fentanyl group (group F,n=22) and buotrphanol group(group B,n=22),the patients in group F received fentanyl 3μg/kg and group B received buotrphanol 40μg /kg intravenos prior to induction of anaesthesia,and followed with an addition of fentanyl 1μg /kg or buotrphanol 30μg /kg beffore pneumoperationeum each group.Tracheal intubation was completed affter an induction whith propofol 2mg/kg and attacurium 0.8 mg/kg.Anaesthesia was maintained with propofol to keep the BIS value was in the range of 40-60,attacurium 0.2mg/kg was additied b if is needed,also the PETCO2 was controled between the range of 35-45mmHg.HR,MAP,SPO2,RR and BIS were recored when getting into the operation room(To),at 4 min after injection of fentanyl or buotrphanol(T1),immediatedly affter intubation (T2),at the beginging of operation(T3),5 min affter pneumoperationeum (T4),5 min before extubation(T5),30min after extubation(T6),6 and 24 hours postoperation.Blood sample was taken from vein when getting into the operating room(T0),immediatedly affter intubation(T2),5 min affter pneumoperationeum(T4) and 30min after extubation(T6) for determinnation of glucose and cortisol.The time of anesthesia and operation togeder with the dosage of propfol in each group were recorded.The scores of sedation and alertness(OAA/S) were got down 30min after extubation.A 10-cm VAS was used to assess the pain intensity at 30min after extubation,6 and 24 hours postoperation.The two groups recovery time were compared and the adverse reaction after operation were observed.Resultthere was no signifiant difference on the indicators before surgery among the two groups(p＞0.05).(1) The heart rate(HR),mean arterial blood pressure(MAP) in two groups increased at T1,T2,T5,decreased at T3,T4,and fall back to the baseline value at T6,there was no signifiant difference between two groups.(2) Level of Glucose and Cortisot increased at T0～T6 compared with the baseline value in both groups,but the difference was not statistically signifficant.(3) The saturation of pulse oxygen(SpO2) signifficantly descended 4 min after injection of fentanyl or buotrphanol(T1)(p＜0.01),and it was significantly lower in group F than in group B(p＜0.05).The respiratory rate (RR) in two groups decreased at T1,but there was no signifiant difference neither between nor in each group.There was one patient turned apnea 3 min affter given fentanyl.(4) the time of extubation and the dosage of propfol in two groups were no signifiant difference.(5) VAS scores and The scores of sedation and alertness(OAA/S) were lower in group B(p＜0.05),VAS scores were significantly lower at T6,6 h postoperation in group B than in group F(p＜0.01),more patients in group B were satisfied with their anaesthesia experience(p＜0.05).(6) there were seven patients in group F coughed after intravenus fentanyl,none took place in group B(p＜0.05).Three patients complained dizzy after intravenus fentanyl and ten after intravenus butorphanol(p＜0.05).Fifteen patients got shiver after extubation in group F and only three persons in group B.Side-effect such as nausea,vomiting and itch were seldom in both groups.Conclusion(1) It is safe and feasible to use butorphanol induced general anesthesia in seletive laparoscopic surgery.(2) Buotrphanol can effectively inhibit stress response in seletive laparoscopic surgery,and haemodynamics is stable in the operation.(3) The sedation was appriciated and postoperative pain was reduced significantly with lower incidence of side effects in group butorphanol,more patients satisfied with their anaesthesia experience.
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