| ObjectiveWe combined different doses of fentanyl with sevoflurane in general anesthesia during laparoscopic cholecystectomy, to investigate the safe and effective dosing of fentanyl.Methods60health elective patients, ASAⅠ～Ⅱ, age21to64years old, underwent general anesthesia for laparoscopic cholecystectomy were chosen. All patients were randomly divided into3groups, group A, B and C (n=20), by different dosing of fentanyl during induction. The dose of fentanyl was4μg/kg,6μg/kg, or8μg/kg respectively, and additional4ug/kg was given at beginning of operation. The mean arterial pressure (MAP), heart rate (HR) and brain electrical double frequency index (BIS) were recorded at different time points. Such as be quiet after entered operating room (To), the lowest values during induction (T1), the highest values within5minutes after endotracheal intubation (T2), the highest values between the beginning of operation to the5th minutes after artificial pneumoperitoneum (T3), the highest values during treatment of cystic duct and cystic artery (T4), the highest values within5minutes before and after extubation (T5). The dose of fentanyl; the wake up time; the extubation time after durg withdrawal, addtional asoactie drugs during anesthesia; naloxone dose during extubation, the incidence adverse reactions of cough and chest wall stiffness during intubation, awareness during operation and postoperative nausea and vomiting were recorded. The breath frequency, Steward awakening score, Prince Henry pain score, Riker sedation, and restlessness score withing5minutes after extubation were recorded as well.Results(1) There was no significant difference (P>0.05) between MAP, HR and BIS at T0; compared group C with group A, MAP was significantly decrease (P<0.05) at T1; At T2, MAP, HR were higher than baseline in group Ahowever, they were lower in group B and C (P<0.05), compared with group B and C, BIS values were significantly higher in group A (P<0.05); At T3, the MAP and HR have no significant different between three groups (P>0.05); At T4, compared with group A, the MAP and HR is significantly decrease at group B and C (P<0.05);At T5, the MAP and HR were increased at all groups’ patients, however, they are more significantly at group A pateints. In addition, MAP and HR is higher in group B than in group C (P<0.05).(2) Except group A metaraminol bitartrate was used1times, atropine sulfate was used1time at group B patients. And metaraminol bitartrate was used5times, atropine sulfate was used1time at group C patients. The chances of cardiovascular drugs usage rates were higher at group C patients than the others.(P<0.05); Naloxone was only given to one pateint at group C for respiratory frequency slows down;(3) At group C, the total dose of fentanyl was significantly higher than group A and B. For additional fentanyl use during operation, there were14patients, including at5pateints, thus, total of19times at group A; The numbers at group B and C was1time respectively. There are significant difference between diffent groups;(4) The wake up time and extubation time are almost same after drup withdrawal within different groups.(P>0.05);(5) The respiration rate and Steward awakening score have no statistically difference within all three groups (P>0.05). Compare with group A, postoperative pain score and agitation score were statistically decrease in group B and C (P<0.05);(6) Postoperative side effects rates were no significant difference between the three groups (P>0.05).ConclusionsCombinesuit dose of fentanyl with muscle relaxants and inhaled anesthetics reduced body and autonomic response, enhanced hemodynamics stability and improvedpostoperative analgesia during general anthesia. In addition, it did not affect the rate of respiratory depression and side effects after general anesthesia. Based on this study,6μg/kg fentanyl induction dose, and addition4μg/kg during operation was safe, effective and feasible at laparoscopic cholecystectomy... |
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