Effects of the Methods of General Anesthesia on the Changes of Blood Prssure and Arterial Carbon Dioxide Tension during Laparoscopic Chosecystectomy

Yeo, Jung Eun; Song, Sun Ok; Kim, Heung Dae; Kim, Hong Jin

Abstract

Laparoscopic cholecystectomy is a relatively new non-invasive surgical procedures, enjoying ever-increasing popularity and presenting new anesthetic challenges. The advantages of shorter hospital stay and more rapid return to normal activities are combined with less pain associated with the small limited incision and less postoperative ileus. During this procedure, the deliberate pneumoperitoneum with carbon dioxide(CO2) insufflation may cause some problems such as hypercarbia, hypertension, pneumomediastinum and other cardiovascular impairments. This study was performed to search a anesthetic method, which has least increase in blood pressure during CO2 insufflation, and to find out whether increased PaCO2 is a major causative factor in the changes of blood pressure during this period. Sixty patients of ASA class 1 or 2 were classified randomly into 3 groups. Group C(control group) was received enflurane-N2O-O2, and others were recieved enflurane-propofol(group P), or enflurane-propofol-fentanyl(group F), respectively. The blood pressure and heart rate were measured at 1 min before CO2 insufflation and 1 min, 5 min, 15 min after insufflation and 1 min before deflation, 5 min after deflation. Also PaCO2 were checked at 1 min before, and 15 min after insufflation. The results were follows ; 1) Changes of arterial pressure : The control group showed most prominent increasing in systolic and mean blood pressure during CO2 insufflation(P<0.05). Group F produced the least increase in blood pressure during CO2 insufflation, compared with group C and P(P<0.05). 2) Changes of heart rate : Although, in the preinsufflation period, heart rates in the group F were significantly lower than other groups, there were no significant changes in heart rates in each group. 3) Changes of PaCO2: There were no siginificant increases in PaCO2 in each group, and no differences between the groups. In conclusion, fentanyl and propofol added light enflurane anesthesia could be a method of the least increase in blood pressure during the laparoscopic cholecystectomy, and increased PaCO2 would not be a major causative factor in hypertension during CO2 insuftlation.