Clinical Studies Of Continuous Intravenous Infusion Of Etomidate Used In Patients Undergoing Laparoscopic Cholecystectomy

Object The thesis aims to investigate the perioperative effect of continuousintravenous infusion of etomidate on patients undergoing laparoscopic cholecystectomyand provide the reference for the clinical use of long-term etomidate infusion.Methods Sixty patients of ASA I~II，age18~55years old， underwent laparoscopiccholecystectomy were randomly divided into etomidate group(group E) and propofolgroup(group P)（n=30). Anesthesia induction: sequential administration ofmidazolam0.05mg/kg， fentanyl3~5g/kg， vecuronium0.1~0.2mg/kg，group E wasgiven etomidate0.3mg/kg， group P was given propofol1~2mg/kg. Anesthesia wasmaintained with remifentanil:5-15g/kg·h pump maintenance，group E received etomidate0.6-1.2mg/kg·h for maintenance， group P received propofol6-10mg/kg·h formaintenance，vecuronium added. SBP、DBP、MAP、HR、SPO2were observed and recordedin following timepoints:Before anesthesia (T0)，after induction of anesthesia (T1)，immediately after intubation (T2)，2mins after intubation (T3)，abdominal inflation (T4)，Separation of the gallbladder (T5)，after operation (T6)；at T0、T6blood gas analysis ofarterial blood were tested，venous blood samples were extracted for the detection of bloodglucose (Glu)，serum creatinine (Cr)，blood urea nitrogen (BUN)；in T0、T6、24h afteroperation (T7) and48h after operation (T8)，venous blood samples were needed fordetermination of plasma cortisol (Cor)， aldosterone (ALD) and ACTH bychemiluminescence immunoassay.Observe and record the time of anesthesia，the recoverytime，extubation time；whether accompanied by muscle tremors，dysphoria， nausea andvomiting，cardiovascular complications and other adverse reactions. Results1.Hemodynamics index:the differences of SBP、DBP、MAP and HR at T0was notstatistical significance (p>0.05)，The SBP、DBP and MAP at T1Compared with T0weresignificantly decreased (p<0.05)，but the P group decreased significantly compared withthe E group(p<0.05)； The SBP，DBP and MAP of group E atT2，3compared with T0increased significantly less than15%.The highest and lowest SBP during the induction andmaintenance of group E was higher than that in group P (P<0.05).2. Arterial blood gas analysis，blood glucose and renal function:The differences inPH、PaO2、PaCO2、HCO3-、TCO2、BE、blood glucose、creatinine、blood urea nitrogenbetween the two groups at T0and T6have no statistical significance(p>0.05)；The PaO2atT6increased (p<0.05) compared with T0but there was no statistical significance betweenthe two groups (p>0.05).3.Adrenal function: changes of preoperative plasma cortisol，aldosterone and ACTHconcentration in two groups had no significant difference at T0（p>0.05）；The cortisolconcentrations of group E decreased at T6and T7compared with T0(P<0.05)，and returnedto the preoperative level at T8；whereas the cortisol concentration of group P at T6hasdecreased slightly (p>0.05)，and recovered to the preoperative level at T7；The ACTH ofgroup E increased significantly at T6，7compared with the group P(p<0.05)，and recoveredto the preoperative level at T8；while in group P，ACTH concentration at T6，7，8comparedwith those at T0showed no statistical significance； Two groups of aldosteroneconcentration at T6，7，8compared with those at T0showed no significant differences(p>0.05).4.Postanesthetic Recovery: The recovery time and extubation time had no significantdifference between two groups (p>0.05)；the muscle vibration，injection pain，nausea andvomiting，agitation，cardiovascular complications of two groups had no significantdifference (p>0.05)；There were no significant differences between the hospitalization timeof two patients (p>0.05).Conclusion Etomidate can be used in general anesthesia induction and maintenance for patients under laparoscopic cholecystectomy.It can make hemodynamics more stabilitythan propofol during induction of anesthesia；It can inhibit adrenal cortex during maintainof general anesthesia for short time but still within the normal range and recovered to thepreoperative level after48hours.