Congyou Zhao*, Wangui Wang and Chunlian Liao

Department of Anesthesiology, The Second People's Hospital of Pidu District of Chengdu, Chengdu, Sichuan Province 611733, China

*Corresponding Author:
Congyou Zhao
Department of Anesthesiology, The Second People's Hospital of Pidu District of Chengdu, Chengdu, Sichuan Province 611733, China
E-mail: 15196660054@163.com
This article was originally published in a special issue,“Recent Progression in Pharmacological and Health Sciences”
Indian J Pharm Sci 2024:86(2) Spl Issue “279-283”

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms

DOI: 10.36468/pharmaceutical-sciences.spl.891

Abstract

To observe the effect of propofol in conjunction with sevoflurane in the anesthesia of individuals undergoing laparoscopic cholecystectomy. Randomly divided into a control and observation group, a total of 200 patients undergoing laparoscopic cholecystectomy between June 2022 and June 2023. Propofol was used for maintenance anesthesia in the control group, while a combination of sevoflurane and propofol was administered to the observation group. The observer’s assessment of alertness/sedation score was employed to evaluate the quality of patient recovery at extubation and 15 min post-extubation. Assessment of recovery conditions encompassed the duration required for spontaneous breathing recovery, awakening, and extubation. Furthermore, stress response-related indicators, such as nitric oxide and adrenocorticotropic hormone, were measured. Additionally, any adverse reactions during the treatment period were carefully recorded. Remarkably higher observer’s assessment of alertness/sedation score were observed in the observation group at both extubation and 15 min post-extubation, as opposed to the control group (p<0.05). Prior to the surgery, there were no substantial variations observed in the levels of nitric oxide and adrenocorticotropic hormone between the two groups (p>0.05). Nevertheless, after a 2 d interval from the surgery, both groups experienced a significant escalation in nitric oxide and adrenocorticotropic hormone levels, with the observation group displaying comparatively lower levels than the control group (p<0.05). The administration of propofol in conjunction with sevoflurane demonstrates a positive impact on anesthesia in patients receiving laparoscopic cholecystectomy. This approach not only improves the quality of recovery but also reduces the time required for anesthesia recovery and lowers stress response-related indicators. Most importantly, it ensures safety and provides controllability.

Keywords

Propofol, sevoflurane, laparoscopic cholecystectomy, anesthesia, gallbladder

Gallbladder diseases, such as gallstones and cholecystitis[1], may arise when the body encounters conditions like gallbladder duct obstruction, inflammation, or bacterial invasion. Recognized for its advantages encompassing minimal trauma, prompt recovery, and mitigated postoperative pain[2], laparoscopic cholecystectomy is a commonly employed treatment modality for gallbladder diseases. The effective management of anesthesia during the surgical procedure plays a pivotal role in ensuring optimal surgical quality and facilitating postoperative recovery for patients[3,4]. Over the past years, propofol and sevoflurane have emerged as commonly utilized drugs in clinical anesthesia. Propofol, administered intravenously, is recognized for its rapid onset, adjustable depth, and potent analgesic properties[5,6]. Conversely, sevoflurane, an inhalation anesthetic, excels in providing precise control over anesthesia depth while effectively maintaining lung functionality[7,8]. However, there is ongoing controversy surrounding the ideal anesthesia technique for laparoscopic cholecystectomy. Thus, the aim of this study is to investigate the effects of propofol in conjunction with sevoflurane in the anesthesia of individuals undergoing laparoscopic cholecystectomy. By providing valuable insights, the results of this study can aid clinical anesthesiologists in deciding upon the most suitable anesthesia approach. Furthermore, the study offers strategies to optimize anesthesia management, ultimately leading to enhanced surgical quality and postoperative recovery outcomes for laparoscopic cholecystectomy patients. In the period from June 2022 to June 2023, a total of 200 patients who were scheduled to undergo laparoscopic cholecystectomy were recruited from our hospital. These patients were randomly assigned to a control group and an observation group, with 100 participants in each group. The control group comprised 53 males and 47 females, ranging in age from 24 y to 74 y, with an average age of (54.65±8.57) y. Similarly, the observation group consisted of 51 males and 49 females, aged between 22 y and 73 y, with an average age of (55.03±8.96) y. No notable distinctions were observed in the general characteristics between the two groups (p>0.05), suggesting their comparability. This study has received approval from the Hospital Ethics Committee, and all participants have duly completed informed consent forms. Inclusion criteria for this study consisted of the following; diagnosed with acute cholecystitis or gallstones as confirmed by B-ultrasound, Computed Tomography (CT), blood routine, and biochemical tests[9]; experiencing varying degrees of biliary colic, persistent right upper abdominal pain, nausea, and vomiting. In exclusion criteria, the presence of circulatory and respiratory system dysfunction; prior use of sedatives or opioids before the surgery; coexistence of cardiovascular and cerebrovascular diseases, severe heart, liver, kidney dysfunction, or endocrine disorders; long-term use of sedatives or hypnotics; diagnosis of mental illness or cognitive impairment and contraindications for surgery or anesthesia were excluded. Prior to the surgery, both groups followed the routine protocol of fasting from food and drink for 8 h. Additionally, intramuscular injections of 0.5 mg atropine (H23021177, Three-Jing Pharmaceutical, China) and 100 mg phenobarbital sodium (H44021888, Bangmin Pharmaceutical, Guangdong, China) were administered. Upon arrival in the operating room, patient’s vital signs were vigilantly monitored. Following the establishment of venous access, a push of propantheline bromide (H20163116, Qidu Pharmaceutical, Shandong, China) at a dose of 5 mg was administered. This was succeeded by an intravenous infusion of scopolamine butyl bromide (H20123332, Shangyi Oriental Pharmaceutical, Jiangsu, China) at a dosage of 0.15 mg/kg, along with a 5 ml dosage of midazolam (H20031071, Enhua Pharmaceutical, Jiangsu, China), 1.5 mg/kg of propofol (H20163406, Jiabo Pharmaceutical, Guangdong, China), and 4 μg/kg of fentanyl (H20030200, Renfu Pharmaceutical, Yichang, China). Anesthesia induction was performed, followed by endotracheal intubation and general anesthesia. The control group received propofol intravenous infusion at a rate of 200 μg/(kg/min) for maintenance anesthesia, while the observation group received 5 % sevoflurane (H20173007, Hengrui Pharmaceutical, Shanghai, China) inhalation therapy on top of the propofol infusion, with an oxygen flow rate of 3 μg/(kg/h). The dosage was adjusted according to the actual situation during the surgery. Using the Observer’s Assessment of Alertness/ Sedation Score (OAAS), the quality of awakening was assessed immediately after extubation and again at the 15 min mark[10]. The OAAS score, ranging from 1 to 5, provides an indication of the awakening quality, with higher scores representing a better outcome. Anesthetic recovery encompasses the duration required for the patient’s spontaneous respiration recovery, awakening, and extubation. Stress response-related indicators has the fasting peripheral venous blood samples, comprising 5 ml, were collected from patients a day before the surgical procedure and 2 d post-surgery. These samples were subsequently analyzed using enzyme-linked immunosorbent assay to measure the levels of Nitric Oxide (NO) and Adrenocorticotropic Hormone (ACTH). The reagents required for the assay were supplied by Qingdao Hantang Biotechnology Company. Statistical Package for the Social Sciences (SPSS) 25.0 will be employed to perform the statistical analysis in this research. Continuous variables will be presented as means and standard deviations, and their analysis will be conducted using t-tests. Categorical variables, on the other hand, will be expressed as frequencies and percentages (n (%)) and assessed using Chi-square (χ2) tests. To establish statistical significance, a threshold of p<0.05 will be utilized. The OAAS scores in the observation group immediately after extubation and 15 min after extubation were higher than those in the control group (p<0.05) as shown in Table 1. Statistically, the observation group exhibited notably shorter intervals for spontaneous respiration recovery, awakening, and extubation as opposed to the control group (p<0.05) as shown in Table 2. The levels of NO and ACTH showed no remarkable differences between the two groups on the day preceding the surgery (p>0.05). However, following a 2 d interval after the surgery, both groups displayed a marked increase in NO and ACTH levels. Moreover, the levels of NO and ACTH in the observation group were found to be substantially lower than those in the control group (p<0.05) as shown in Table 3. Both groups of patients encountered adverse reactions, such as nausea, vomiting, bradycardia, and increased secretions. Nevertheless, there was no notable distinction seen in the overall incidence of adverse reactions between the observation group and the control group (p>0.05) as shown in Table 4. In recent years, with the widespread adoption of minimally invasive techniques, laparoscopic cholecystectomy has become the preferred surgical method for treating diseases such as gallstones and cholecystitis due to its advantages of minimal trauma, fewer complications, and faster postoperative recovery[11,12]. General anesthesia with endotracheal intubation is the usual approach for performing the surgery, but postoperative pain at different levels remains an ongoing concern. Notably, postoperative pain is a primary factor contributing to patient agitation during the recovery phase[13,14]. Consequently, the careful selection of suitable anesthetic agents during the surgical procedure holds great significance. The purpose of this research was to figure out the influence of propofol in conjunction with sevoflurane in anesthesia for laparoscopic cholecystectomy, comparing its effects on the quality of awakening, anesthetic recovery, and stress response-related indicators in patients. The results showed that the OAAS scores in the observation group immediately after extubation and 15 min after extubation were higher than those in the control group, and the observation group had shorter times for spontaneous respiration recovery, awakening, and extubation compared to the control group. Additionally, the levels of NO and ACTH in the observation group were significantly lower than those in the control group after 2 d of surgery. Firstly, the higher OAAS scores in the observation group indicate that propofol in conjunction with sevoflurane can improve the quality of awakening during the postoperative recovery process. The higher OAAS scores may be attributed to the effects of propofol, which possesses sedative and anxiolytic properties, promoting patient comfort and a sense of calmness during anesthesia[15]. Secondly, the shorter times for spontaneous respiration recovery, awakening, and extubation in the observation group suggest that propofol in conjunction with sevoflurane can facilitate the recovery of spontaneous respiration and consciousness, thereby shortening the anesthetic recovery time. This may be attributed to the characteristics of propofol, which include rapid metabolism and quick recovery of wakefulness. Additionally, sevoflurane, as an inhalation anesthetic, also exhibits faster onset and offset effects, and its combined application with propofol may enhance the effectiveness of anesthetic recovery. Moreover, after a 2 d period following the surgery, the observation group displayed remarkably lower levels of both NO and ACTH in comparison to the control group. These findings indicate a potential enhancement in suppressing the postoperative stress response in the propofol combined with sevoflurane group. NO is an essential cellular signaling molecule, and its increased levels may be associated with postoperative inflammation and oxidative stress[16]. ACTH, on the other hand, is an important regulator of the body’s stress response, and its elevated levels may be associated with the enhancement of postoperative stress response[17]. The lower levels of NO and ACTH in the observation group compared to the control group may suggest that propofol in conjunction with sevoflurane can attenuate the occurrence of postoperative stress response, demonstrating certain anti-inflammatory and anti-stress effects. Both patient groups encountered adverse reactions, including nausea, vomiting, bradycardia, and increased secretions. However, the overall incidence of adverse reactions did not substantially differ between the observation group and the control group. These findings suggest that the application of propofol combined with sevoflurane is associated with a comparable safety profile in terms of adverse reactions. However, this study is subject to certain limitations. Firstly, as a single-center study, potential selection bias could arise. It is advisable to explore further multicenter studies with increased sample sizes to corroborate the findings of this study and examine the indications and benefits of incorporating propofol combined with sevoflurane in anesthesia for laparoscopic cholecystectomy. The administration of propofol in conjunction with sevoflurane demonstrates a positive impact on anesthesia in patients receiving laparoscopic cholecystectomy. This approach not only improves the quality of recovery but also reduces the time required for anesthesia recovery and lowers stress responserelated indicators. Most importantly, it ensures safety and provides controllability.

Group n OAAS score
Immediately after extubation 15 min after extubation
Observation 100 3.87±0.81 4.68±0.58
Control 100 2.84±0.63 3.81±0.77
t -9.008 -8.829
p 0.000 0.000

Table 1: Quality of Awakening (Points, X±S)

Group n Autonomous breathing recovery time Wake-up time Extubation time
Observation 100 7.58±1.81 8.87±1.72 11.94±3.28
Control 100 9.20±1.82 12.82±2.69 14.79±3.89
t 6.595 12.451 5.895
p 0.000 0.000 0.000

Table 2: Anesthesia Recovery Status (Min, X±S)

Group n NO (μmol /ml) ACTH (pg/ml)
Before After Before After
Observation 100 413.35±107.22 201.81±67.28* 30.18±4.76 36.38±5.93*
Control 100 416.14±102.85 252.27±78.34* 29.61±4.88 43.73±6.46*
t -1.287 4.842 0.073 7.270
p 0.200 0.000 0.942 0.000

Table 3: Stress Response Related Indicators

Group n Nausea and vomiting Bradycardia Increased secretion Overall incidence
Observation 100 3 (3.0) 2 (2.0) 5 (5.0) 10 (10.0)
Control 100 5 (5.0) 5 (5.0) 4 (5.0) 14 (14.0)
χ2 0.758
p 0.384

Table 4: Adverse Reactions N (%)

Conflict of interests:

The authors declared no conflict of interests.

References