| Objective: To investigate the effects of different does of sufentanil applied in general anesthesia of gynecological cancer patients, in order to explore the appropriate dose of the sufentanil.Methods: Sixty ASA gradeâ… orâ…¡patients,scheduled for elective extensive total hysterectomy and bilateral adnexectomy and pelvic lymphadenectomy, were randomly divided into four groups with 15 patients in each group: S1(potency ratio=10), S2 (potency ratio=7)·S3(potency ratio=5) were administrated in group S1,S2,S3 ,group·fentanyl.Group S1-S3 sufentanil's dose was determined by the effects of sufentanil and fentanyl of the ratio of 5:1,7:1,10:1. All the patients underwent total intravenous anesthesia. For induction, midazolam 0.08mg/kg, vecuronium 0.12mg/kg and propofol 2mg/kg were given to all groups.sufentanil 0.3μg/kg,0.42μg/kg,0.6μg/kg and fentanyl 3μg/kg were respectively administrated to the above four groups.After intubation, anesthesia was maintained with sufentanil(0.3μg/kg/h,group S1), sufentanil (0.42μg/kg/h, group S2), sufentanil(0.6μg/kg/h,group S3)or fentanyl (3μg/kg/h,group F) combined with propofol 0.05～0.1mg/kg/min, graded intravenous injection of vecuronium to maintain muscle relaxation, adjusted the propofol concentration according to hemodynamics·30～45 minutes before the end of of the surgery·injection of sufentanil or fentanyl were discontinued. The occurrence of choking was observed and recorded. Moreover the following variables were recorded:.MAP,HR before induction,after intubation,1,3,5,10 minutes after intubation,at incision,30,60,120 minutes after incision,at the end of surgery,at palinesthesia, before extubation,and 1,5,10,20,30 minutes after extubation. Vasoactive drugs, time for return of spontaneous ventilation,return of analepsia, extubation and postoperative complications were also recorded.Results:The four groups did not differ with respect to age,body weight, duration of anesthesia, preoperative values of MAP and HR(P>0.05).Four groups'MAP and HR values after induction were decreased compared to baseline values (P <0.05).In group S1,there was no statistical difference between preoperative values and post-intubation values at any time point for MAP and HR.(P>0.05),in group S2, S3 MAP and HR values were lower than baseline values at any time after intubation (P <0.05);in group F,MAP and HR values were higher than baseline values at 1,3 minute after intubation(P <0.05), in group S3,MAP and HR values were lower than those in group S1 at any time after intubation(P <0.05), MAP and HR in groupF was significantly higher than those in group S1, S2, S3 1,3 minutes after intubation (P <0.05). During maintainence of anaesthesia, in group S1 ,MAP values were significantly higher than baseline values at incison and the end of surgery(P>0.05), In group S2, S3 ,F·there was no statistical difference between preoperative values and intra-operative values at any time point for MAP (P>0.05), In group S1, S2, S3,HR was lower than basic values at any time of intra-operative(P <0.05), in group F,HR values were higher than that in group S1, S2at the end of operation(P <0.05). In group S3 ,the number of patients whose MAP were above 120% of baseline values and thus needing antihypertensive treatment was lower than that in the group S1, S2 ,F(P <0.05),in group S3,F, the number of patients whose HR above 100 beats per minutes and thus needing metoprolol treatment was less than that in the group S1(P <0.05), in group F,the number of patients whose HR below 55 beats per minutes and thus needing atropin treatment was more than that in the group S1, S2, S3(P <0.05).In the PACU, in group S1, MAP vaules was higher than baseline values at palinesthesia (P <0.05),in group S2and S3·there was no statistical difference between preoperative values and in the PACU values at any time point for MAP (P>0.05), in group F,MAP was higher than baseline values at any times in the PACU(P <0.05),MAP in group S3 was lower than that in group S1, S2 at palinesthesia (P <0.05), MAP in group·was higher than that in group S3 at palinesthesia and 20 minutes after extubation (P <0.05), in group S1, S2, S3,HR was no significant differences compared basic values at any times in the PACU(P <0.05), in group F, HR was higher than basic values at palinesthesia, before extubation and 1,5minutes after extubation. The time to spontaneous ventilation,analepsia and extubation, group·were longer than the group S1, S2, S3 (p<0.05). In group S3, the number of patients suffering irratation and demanding analgesics 2h after operation was less than that in groups of S1 and·(P <0.05), in group F, the number of patients suffering irratation and demanding analgesics 2h after operation was more than that in groups of S2 and S3 (P <0.05). The incidence of neasea and vomitting did not differ (P>0.05).Conclusion: Sufentanil 0.3μg·kg-1 is the best dosage of the induction,it can suppress the patient's stress responses during tracheal intubation,it also can maintain stable hemodynamics duing induction of anesthsia. Continuous infusion of sufentanil 0.6μg·kg-1·h-1 and propofol,when used in elective gynecologic cancer surgery, had strong effect of analgesia,and it was easy to control the depth of anaesthsia,maintain hemodynamic stability.In groups of S2 and S3 that the patients might recover quickly and likely avoid irritation .When in the induction of anesthesia,maintenance of anesthesia and after anesthesia, fentanyl equivalent dose sufentanil compared with fentanyl group was more stable hemodynamics, effect stronger of analgesic, faster of wake. Therefore, total intravenous anesthesia use sufentanil is more secure.
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