Changes in blood glucose during surgery laparoscopic cholecystectomy under general anesthesia with two method: remifentanil-propofol and remifentanilsevofluran

Surgery under general anesthesia induces endocrine,immunologic and metabolic responses. During operation,insulin secretion is disturbed and glucose application decreases, catabolic hormons concentration and glucose production increase and hyperglycemia occurs. Hyperglycemia is considered as an independent risk factor for surgery related mortality and morbidity. This study is designed to compare propofol and sevoflurane in blood glucose and hemodynamic variations and post-op nausea-vomiting in laparoscopic cholecystectomy under general anesthesia. This randomized clinical trial was conducted on 320 patients undergoing elective laparoscopic cholecystectomy. They were randomly assigned into remifentanil-propofol (n=160) and remifentanil-sevoflurane (n=160) groups. All patients received intravenous midazolam 1-2 mg, fentanyl 2-3μg/kg and general anesthesia was induced by STP 3-5mg/kg, atracurium 0.5mg/kg or cisatracurium 0.15mg/kg and anesthesia was maintained in 1st group by infusion of remifentanil (0.1-1μg/kg/min) and propofol (50-150 μg/kg/min) and in 2nd group by remifentanil (0.1-1μg/kg/min) and sevoflurane (0.8-1.8% MAC). Blood glucose values and hemodynamic variables was evaluated and recorded in certain times of anesthesia as well as post-op nausea-vomiting. Blood glucose values, mean arterial pressure and heart rates in 1st group (remifentanilpropofol) was significantly lower than 2nd group (remifentanil-sevoflurane) (p<.001).Incidence of post - op nausea-vomiting was not significantly different(p=.36) Maintenance of anesthesia by remifentanil - propofol infusion in comparison with remifentanil-sevoflurane leads to less increase in blood glucose, and lower mean arterial pressure and heart rate values, which reveals less stress response and better hemodynamic stability of propofol; especially in patients with underlying deceases.