Hemodynamic changes and stress response during BIS-guided TCI anesthesia with propofol-fentanyl in laparoscopic versus open cholecystectomy

Background
Laparoscopic surgery produces measurable effects on cardio-circulatory, respiratory and metabolic systems. Total intravenous anesthesia with propofol using target-controlled infusion technique guided by Bispectral Index monitoring ensures an optimum level of anesthesia. This study was designed to evaluate the hemodynamic changes with the use of BIS-guided TCI with propofol-fentanyl during either laparoscopic or open cholecystectomy.
Methods
Twenty-four ASA class I-II patients, scheduled for cholecystectomy under general anesthesia using BIS-guided TIVA with propofol-fentanyl delivered by TCI pump, were divided surgically into laparoscopic surgery group (LS group,  = 12) and open surgery group (OS group,  = 12). Hemodynamic data as well as stress hormones were measured at various time intervals.
Results
Within LS, there was rise of both cardiac output after abdominal insufflation ( < 0.05) and stroke volume after end of surgery ( < 0.05). Blood pressure decreased in the two groups after insufflation in LS and skin incision in OS ( < 0.01) as well as after 15 min ( < 0.05 &  < 0.01 respectively). LS showed decrease in SVR starting from insufflation till end of surgery, while OS showed this decrease only with skin incision. Heart rate decreased 15 min after surgical incision till end of surgery in OS while LS showed decrease only after end of surgery. Only in OS, norepinephrine & epinephrine levels showed significant rises throughout the period of study ( < 0.001). Cortisol level was elevated after 30 min in LS while OS showed a rise after the end of surgery ( < 0.001). ACTH levels increased in OS ( < 0.001). There was positive correlation between CO and epinephrine, norepinephrine and ACTH in OS.
Conclusion
BIS-guided TCI anesthesia with propofol-fentanyl offers a good and safe anesthesia technique for patients undergoing either laparoscopic or open cholecystectomy. The hemodynamic stability guided by esophageal Doppler monitor makes it a very appealing choice.