| Introduction:The female sex hormones change in a cyclical manner in different menstrual cycle (such as:follicular phase, luteal phase). Endogenous female sex hormones include estrogen, progesterone, follicle-stimulating hormone (FSH) and luteinising hormone (LH).In addition to the reproductive behavior function, the female sex hormones play a corresponding role to each other systems in human body. Of all the sex hormones, progesterone and its metabolites (e.g. allopregnanolone) are identified to have relation with sedation. Now the research whether the female sex hormone influence general anesthesia causes more and more attention, unfortunately, few studies reported.General anesthesia means human body central nervous system is irregularly descending inhibited by general anesthetics, leads to a state of loss of consciousness and the disappearance of pain, sedation (loss of consciousness) is an important purpose of general anesthesia. Propofol is a kind of weak acidic emulsion, has the characteristics of fast action and short effective time. Because of its induction, maintain stable, recovery quick and complete, without obvious accumulation effect, it is now widely used in clinical and used as the main intravenous anesthetics.the main objective of this study is to compare the value of predicted effect site concentration (Ce) of propofol to LOC(OAA/S<2) in50%(ED50for LOCin different menstrual cycle, to determinate the serum concentrations of hormones, the Ce value of propofol and the value of BIS at LOC and wakeup, discuss the correlation of them and research the possible mechanism.Material and methods:60adult female patients, aged18～40years, ASA Ⅰ-Ⅱ, undergoing gynaecological laparoscopy were included, none of them was premedicated. The60cases were divided into two groups according to different menstrual cycle:follicular group and luteal group, each group had30patients.Anesthetic method:anesthesia was induced and maintained with propofol, remifentanyl and rocuronium. Propofol and remifentanyl were administered via TCI pump using effect-site concentration as predicted concentration. For propofol administration, the predicted effect-site concentration of the first patient in each group received was3.5μg-ml-1, which was modified according to the up-and-down method. The level of sedation was determined by the responsiveness portion of the OAA/S, LOC was defined as an OAA/S<2(loss of responsiveness to light tapping on left shoulder or mild shaking with voice command to open eyes). When the patient losed consciousness, remifentanyl and rocuronium were given, the predicted effect-site concentration of remifentanyl was set at4.0ng-ml-1. Throughout surgery, the propofol infusion rate was adjusted to maintain the BIS value between40and60. The remifentanyl infusion rate was also adjusted according to intraoperative hemodynamic changes.Two groups of patients were taken venous blood sample3ml before they came into operation room half an hour. The blood samples were collected in standard sample tube of anticoagulation or the tube containing separation gel and stored in a freezer at2-8℃, used to test female sex hormone level (including estrogen, progesterone, FSH and LH). The basic vital signs were recorded every5min, the value of BIS, PCEprop and PCEremi were also recorded at the point such as:LOC, BIS50, wakeup and so on. Some of the complications following operation (including postoperative half an hour and24hours) were observed.Result:(1) In follicular group and luteal group, the value of BIS at LOC and wakeup had no significant difference (P>0.05).(2) The value of ED50for LOC of propofol in luteal group was lower than follicular group (P<0.05).(3) The propofol effect-site concentration at LOC and BIS50in luteal group was significantly lower than that in follicular group (P<0.01), and it was negatively correlated to progesterone level but not correlated to E2, FSH and LH.(4) The emergence time of the patients in luteal group was significantly shorter than that in follicular group (P<0.01), and it was also only negatively correlated to progesterone level.(5) The incidence of PONV in follicular group was higher than that in luteal group (P<0.05).Conclusion:(1) The change of female sex hormone level in different menstrual cycle does not affect the expression of the BIS value to the depth of sedation.(2) The dosage of propofol for general anesthesia induction was reduced in luteal group, pointed out progesterone levels was one of the reasons, concluded that progesterone may have sedative-like effect.(3) Progesterone can shorten recovery time. |
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