The Efficacy Of Combined Use Of Nicardipine And Esmolol Pumping Continuously During Perioperative Laparoscopy

Objective:In the laparoscopic cholecystectomy,artificial pneumoperitoneum can cause the change of haemodynamics and main feature is cardiac output decreased,and the arterial pressure increased and systemic vascular resistance increased.,while the changes are particularly prominent in patients who were at high risk of heart disease.Currently clinical research about usage of nicardipine and esmolol in maintaining hemodynamic stability during pneumoperitoneum has been proceeded.The data collected is often localized to one kind of index and the results cannot reflect the impact of drugs which are used to weaken effect of pneumoper itoneum.In this research,two groups of patients who undergoing laparoscopic cholecystectomy under general anesthesia were scheduled for Narcotrend to monitor the depth of anesthesia.In the control group,we used intravenous anesthesia with remifentanil and propofol to maintain the depth of anesthesia,while in the experimental group continuous intravenous infusion of small doses of nicardipine an d esmolol additional were used.The changes of vital signs and the dosage expended in the operation and the recovery time and postoperative complications were compared between the two groups.We can observe the effects of nicardipine and esmolol on hemodynamics in laparoscopic cholecystectomy.Methods: Sixty patients under going selective laparoscopic cholecystectomy were randomly assigned into two groups.The patiengs with hypertention,diabetes mellit us,bradycardia,atrioventricular block,bronchial asthma,allergic and someone who take ?-receptor blocker or calcium channel blocker before surgery were excluded.In the control group anesthetic drugs was given only;In the experiment group,niacar dipine 2mg and esmolol 100 mg combined were diluted into 20 milliliter with normal saline and followed by intravenous continuous infusion at the rate of 0.09⁰.18ml/?kg.h?after induction with fentanyl,etomidate and rocuronium iv.Stop pumping when pneumoperitoneum was over.After LMA intubation,anesthesia was maintained with remifentanil and propofol.During operation with CO2 pneumoperitoneum,MAP was maintained within ±15% of baseline value and NTI within D0^D2?64³7?.SBP,DBP,HR,PETCO2,NTI and the dose of remifentanil and propofol,anesthe sia time,surgery time,the recovery time from anesthesia,the time of removing LMA.The follow up postoperative was done within 24 h about nausea and vomiting,hoarse,sore throat and awareness.Results:In the control group,diastolic blood pressure and heart rate significantly increased which lasted to the end of CO₂ after pneumoperitoneum,while in the experiment group,DBP and HR were elevated a little and fell soon,RPP was reduced after surgery,while compared with the control group,there was significant difference in the experimental group?P<0.01?.During the operation the doses of propofol were significantly less than that in the control group,recovery times from ane sthesia and extubation time were shorter.Conclusion:1?the application of combined use of nicardipine and esmolol injected continually was safe and effective,which can prevent the sympathetic response during laparoscopic cholecystectomy.2?the application of combined use of nicardipine and esmolol infusion would be ascendency than the control group who used anesthesia drugs only.