Application of remifentanil-propofol-fentanyl anesthesia to laparoscopic choledocholithotomy for elderly patients

【Objective】To evaluate the effect of remifentanil-propofol-fentanyl total intravenous anesthesia in laparoscopic cholecystectomy and choledocholithotomy for elderly patients.【Methods】Sixty cases of elderly patients(ASAⅠ-Ⅲ) who had received laparoscopic cholecystectomy and choledocholithotomy by date,were selected and randomly divided into two groups(30 cases for each group),namely,remifentanil-propofol-fentanyl group(group A) and remifentanil-propofol-isoflurane group(group B).And then the cardiovascular response was observed before and after intubation.The time for recovery of patients' autonomous respiration,eye opening,and extubation was recorded.The conscious state,VAS after 24 hour and volume of additional analgesic of patients at the very moment of extuba-tion and the 20th minute after extubation were observed.The frequency of intraoperative awareness and side effects(e.g.nausea and vomiting) in 24 hours after operation were also recorded.【Results】The SBP,DBP and HR of patients were not significantly different at the 1st minute before intubation and significantly different at the 1st minute after extubation between group A and group B,were significantly different between the time before intubation and 1 min after extubation in group B,and were insignificantly different between 1 min after intubation and before extubation in group A.The awareness of patients in group A was clearer than that in group B at the very moment of and 20 minutes after extubation.VAS after 24 hour in group A was significantly different from that in group B(P 0.05).The side effects in group A during the intubation period were significantly weaker than those in group B(P 0.05);the time for recovery of patients'autonomous respiration,eye opening,and extubation in group A was significantly shorter than that in group B.Intraoperative awareness occurred in neither of the groups,and the incidence rate of nausea and vomiting in group A was lower than that in group B(P 0.05).【Conclusions】Using remifentanil-propofol-fentanyl for total intravenous anesthesia,the awakening quality is good,the blood circulation is stable,and inci-dence rate of nausea and vomiting is lower.Thus,remifentanil-propofol-fentanyl can be safely used in the anesthesia for elderly patients.