Clinical application of remifentanil and propofol in total intravenous anaesthesia for elderly patients undergoing laparoscopic cholecystectomy

Objective To compare the effects and safety of anesthesia with intravenous infusion of remifentanil and propofol in elderly patients undergoing laparoscopic cholecystectomy.Methods Forty elderly patients (ASA I-II) undergoing elective laparoscopic cholecystectomy were randomly divided into total intravenous anesthesia group(group R,n=20) and inhaled anesthesia group(group I, n=20). The induced anesthesia was performed with midazolam 0.04mg·kg-1,propofol 1.5 mg·kg-1,fentanyl 4 μg·kg-1 and vecuronium 0.1 mg·kg-1 in both groups. The anesthesia was maintained by pumping remifentanil 0.2-0.5 μg·kg-1·min-1, propofol 6 mg·kg-1·h-1 with micropump in group R, while patients in the group I, maintained with inhalation of 1.5%-2.5% isoflurane. Hemodynamic changes were monitored during anesthesia. Some indices ,such as SBP,DBP,MAP,HR and SPO2 , were recorded at 5 intervals including before anesthesia,1, 5min after pneumoperitoneum ,at the end of pneumoperitoneum and at the end of operation.Recovery time,OAAS score after extubation,postoperative nausea and vomiting(PONV) and other postoperative complications were observed. Results MAP and HR increased significantly after pneumoperitoneum (P0.05) in group I ,whereas there was no significant change in MAP and HR in group R. Data of hemodynamics in group I were significantly higher than those in group I during operation(P0.05).Recovery time in group I was significantly longer than that in group R(P0.05).The patients in group R had higher OAAS scores after extubation than those in group I (P0.05).The incidence of PONV in group R was lower than that in group I(P0.05).Conclusion The intravenous anesthesia using remifentanil and propofol is effective in keeping the stability of hemodynamics, making awake quickly. It is a good method for elderly patients undergoing laparoscopic cholecystectomy.