Total intravenous anesthesia with a step-by-step target-controlled infusion of remifentanil and propofol in elderly patients

Abstract

Objective To observe the restrain of stress reaction,circulation stability and the pal-inesthesia from anaesthesia during a step-by-step target-controlled infusion (TCI) of remifentanil in elderly patients under laparoscopic cholecystectomy. Methods Sixty ASA class Ⅰ -Ⅱ patients were randomly di- vided into 5 groups:15 ease each group. A dose of 0.06 mg/kg fentanyl was given in group A,4.0 μg/L blood plasma target level of fentanyl was given in group B,4.0 μg/L blood plasma target level of remifen-tanil was given in group C, and blood plasma target level of remifentanil was given from 2.0 μg/L to 4.0 μg/L step by step in group D during anesthesia. Midazolam, propofol and vecuronium bromide were also given during anesthesia induction. Hemodynamic parameters at T0, T1, T2, T3 and T4 were recorded, and the concentrations of serum corticosteroid, aldosterone and blood sugar determined. The time of extubation, return to ward ,OAA/S score after extubation ,and OAA/S score to 5 was recorded. The use of vasoactive a- gent during operations was also recorded. Results MAP and HR were decreased during anesthesia induc- tion in 4 groups,and more significant in group C (P <0.05 ). MAP and HR were increased during trachea extubation in 4 groups,and more significant in groups A, B (P < 0.05 ). The concentrations of corticoste-roid and aldosterone were increased significantly at T4 compared to T0(P < 0.05 ). The frequency of using vasoactive agents was increased significantly in group C(P < 0.05 ). The time of extubataion, leaving PACU, and OAA/S score to 5 was significantly shortened in groups C, D(P < 0.05 ). The OAA/S scores were significantly higher in groups C, and D than in groups A, and B(P < 0.05 ). Conclusion TCI of remifentanil can restrain stress reaction caused by tracheal intubation and operation stimulation effectively, and provide quickly palinesthesia with high quality in elderly patients, but a step-by-step TCI of remifen- tanil can provide more stable circulation. Key words: Aged ; Target-controlled infusion; Remifentanil; Stress reaction