Efficacy of different methods of anesthesia for laparoscopic hysterectomy

Abstract

Objective To investigate the efficacy of different methods of anesthesia for laparoscopic hysterectomy.Methods Sixty ASA Ⅰ or Ⅱ patients,aged 45-60 yr,weighing 55-65 kg,scheduled for laparoscopic hysterectomy,were equally and randomly divided into 2 groups:combined intravenous-inhalational anesthesia group (group Ⅰ ) and combined spinal-epidoral anesthesia (CSEA) + general anesthesia group (group Ⅱ ).In group Ⅰ,anesthesia was maintained with inhalation of sevoflurane and infusion of remifentanil after induction of anesthesia.In group Ⅱ,CSEA was performed,after the upper level of sensory block was stable,general anesthesia was induced and maintained with inhalation of sevoflurane,and state entropy (SE) was naintained at 45-60.Arterial blood samples were taken to determine the plasma concentrations of adrenaline ( AE ),norepinephrine (NE) and dopamine (DA) after admission to the operation room,after completion of pneumoperitoneum,at 10 min after pneumopentoneum,during uterus traction,during removal of the laryngeal mask airway,and at 10 min after removal of the laryngeal mask airway (T0-5).The time for recovery of spontaneous breathing,extubation time,and time of regaining consciousness were recorded at the end of operation.The side-effects and number of patients requiring increments of analgesics were also recorded within 48 h after operation.Patient' s satisfaction was recorded at 48 h after operation.Results Compared with group Ⅰ,the plasma concentrations of AE and NE at T3-5 and the plasma concentrations of DA at T3,5 were significantly decreased,the time for recovery of spontaneous breathing,extubation time,and time of regaining corsciousess were significantly shortened,and the incidence of agitation and the number of patients requiring increments of analgesics were significantly decreased in group Ⅱ ( P ＜0.05).There was no significant difference in the incidence of intraoperative awareness,and nausea and vomiting after operation,and the level of patient' s satisfaction at 48 h after operation between the two groups ( P ＞ 0.05).Conctusion CSEA + general anesthesia has better efficacy than combined intravenous-inhalational anesthesia when used for laparoscopic hysterectomy. Key words: Anesthesia,general; Anesthesia,inhalation; Anesthesia,spinal; Anesthesia,epidural; Laparoscopy