[Anesthetic management with remifentanil infusion during laparoscopic cholecystectomy]

In the anesthetic management of laparoscopic surgery, hemodynamic changes appear on the skin incision and pneumoperitoneum. Remifentanil may suppress the cardiovascular changes on the pneumoperitoneum in the laparoscopic cholecystectomy (LC).

One hundred-seven patients scheduled for LC were assigned into two groups; remifentanil (R), and epidural (E) groups. In R group, remifentanil was administered at 0.2 microg x kg(-1) x min(-1) from the induction of anesthesia. In E group, an epidural catheter was placed between T10-12 and 0.2% ropivacaine was infused continuously at 6 ml x hr(-1) via epidural catheter. Anesthesia was maintained by propofol at 5 mg x kg(-1) x hr(-1) following the induction by propofol and vecuronium in both groups. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and bispectral index (BIS) were compared at the entrance of the operating room, skin incision, pneumoperitoneum and extubation of the endotracheal tube between two groups.

At the pneumoperitoneum, statistical significance was found in HR, but there was no significant difference in blood pressure and BIS between the two groups.

Compared with epidural anesthetic management, remifentanil suppresses significantly the elevation of heart rate, but not blood pressure at the pneumoperitoneum.