A Comparative Study Of Malignant Anemia On The Anesthetic Effcacy Of Sevoflurane Based-Inhalational Anesthesia Or Propofol Intravenous Anesthesia

Objective: To compare different degree of malignant anemia on the anesthetic efficacy of sevoflurane based-inhalational anesthesia and propofol intravenous anesthesia through dose of anaesthetic drug,intraoperative haemodynamic change,recovery index and changes of perioperative 5-HT,cortisol.Methods: A total of 120 patients undergoing elective laparoscopic surgery during general anesthesia in our hospital were enrolled in this prospective study.According to the preoperative level of hemoglobin,these patients were divided into three groups: normal hemoglobin group(group A: n = 40,Hb ? 120 g/L),mild anemia group(group B,n = 40,90 ? Hb < 120 g/L),moderate anemia group(group C: n = 40,60 ? Hb < 90 g/L),and then divided into two subgroups: sevoflurane inhalation anesthesia(S group,n = 20)and intravenous anesthesia with propofol(P group,n = 20).Both groups used the same method for the anesthesia induction,which used propofol with plasma concentration of target control infusion and sufentanil with effect target-site infusion under the guidance of BIS.Group P kept invariant in the maintenance of anesthesia while group S stopped the propofol for sevoflurane.The value of pulse oxygen saturation(Sp O2),mean blood pressure(MBP),heart rate(HR)and bispectral index(BIS)were recorded at following time points: before induction(T1),before intubation(T2),intubation(T3),pneumoperitoneum(T4),extubation(T5)and 2 hours after operation(T6).The pressure and duration of pneumoperitoneum,volume of hemorrhage,volume of transfusion of fluid and blood were counted;administration of vasoactive agents,dosage of propofol or sevoflurane,time to open eyes,time to intubation,incidence of postoperative agitation,and incidence of postoperative nausea and vomiting between each group were compared.The concentration of cortisol and 5-serotonin(5-HT)in serum were assessed by enzyme linked immunosorbent assay.Results: The dosage of sevoflurane between the S group did not have a significant difference.But in the P group,the dosage of propofol was significant different between the moderate anemia and the normal anemia.Time intervals to eye opening with group S was significant shorter than group P,but the incidence of postoperative nausea,vomiting and dysphoria was significant higher than P group.The cortisol and 5-HT concentrations at T3 and T5 were significant higher than T1,while the T2 was lower than it.Conclusion: Patients who received sevoflurane inhalation anesthesia revived from anesthesia faster but the incidence of postoperative nausea,vomiting and dysphoria were significant higher than intravenous anesthesia,while they have similar anti-stress ability.Moderate anemia patients had a less propofol dosage and a volatile hemodynamics.