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| Anesthesia effect of different anesthesia protocols during laparoscopic myomectomy and their influence on the stress response and cognitive function of patients |
| Xinhua Hospital of Xinhua Medical Group, Huainan, Anhui Province,23000 |
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Abstract To explore the anesthesia effect of sevoflurane or propofol combined with remifentanil during laparoscopic myomectomy, and to study their influence on stress response and cognitive function of the patients. Methods: A total of 80 patients who underwent laparoscopic myomectomy were randomly divided into observation group and control group(40 cases in each group) from January 2018 to January 2021. The patients in the control group were given anesthesia by propofol combined with remifentanil, while the patients in the observation group were given anesthesia by sevoflurane combined with remifentanil. The perioperative indicators, such as anesthesia time, operation time, intraoperative bleeding volume, awakening time, extubation time, and Steward awakening score, of the patients in the two groups were observed. The hemodynamic and stress response indexes of the patients at 10 min before anesthesia(T1), 5 min after intubation(T2), 30 min after pneumoperitoneum(T3), and at the end of surgery(T4) were compared between the two groups. The cognitive function scores and the levels of serum neuron-specific enolase(NSE) and S-100β protein of the patients in 1d before operation, 1d after operation, and 3d after operation were compared between the two groups. Results: The anesthesia time, the recovery time, and the Steward recovery score of the patients in the observation group at 30 minutes after operation were significantly lower than those of the patients in the control group(P<0.05). There were no significant differences in operation time and intraoperative blood loss of the patients between the two groups(P>0.05). There were no significant differences in the hemodynamics and the stress response of the patients at T1 between the two groups(P>0.05). The values of heart rate(HR), and the mean arterial pressure(MAP), and the levels of serum norepinephrine(NA), cortisol(Cor), adrenocorticotropic hormone(ACTH), epinephrine(A), and blood glucose(GLU) of the patients in the observation group at T2, T3, and T4 were significantly lower than those of the patients in the control group, and the oxygen saturation(SpO2) value of the patients in the observation group was significantly higher than that of the patients in the control group(all P<0.05). There were no significant differences in the mini-neurological state examination(MMSE) score, the time of media test(TMT) required, and the serum NSE and S100β levels of the patients in 1 day before operation between the two groups(P>0.05). The MMSE scores of the patients in the two groups in 1 day and 3 days after operation were significantly lower than those in 1 day before operation, the time required for TMT, and the serum NSE and S100β levels of the patients in 1 day and 3 days after operation in the two groups were significantly higher than those in 1 day before operation. The MMSE scores of the patients in the observation group in 1 day and 3 days after operation were significantly higher than those of the patients in the control group, the time required for TMT and the serum NSE and S100β levels of the patients in the observation group in 1 day and 3 days after operation were significantly lower than those of the patients in the control group(all P<0.05). Conclusion: The application of sevoflurane combined with remifentanil during laparoscopic myomectomy of the patients helps to their hemodynamic stability during the anesthesia period and can effectively shorten the postoperative awakening time and improve the awakening quality, which has exact efficacy as for inhibiting intraoperative stress response and reducing postoperative cognitive impairment.
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