The purpose of this study was to compare the effects of esmolol, esmolol and nicardipine or remifentanil on MBP, HR and recovery in gynecologic laparoscopic surgery.

Eighty patients scheduled for gynecologic laparoscopic surgery were randomly allocated to four groups: group C (control group, n = 20); group E (esmolol group, n = 20) received esmolol 1 mg/kg, followed by 5 µg/kg/min; group EN (esmolol + nicardipine group, n = 20) received esmolol 1 mg/kg and nicardipine 15 µg/kg, followed by an esmolol infusion 5 µg/kg/min; and group R (remifentanil group, n = 20) received remifentanil 1 µg/kg, followed by 0.05 µg/kg/min. The MBP and HR were measured at preinduction, after induction, at 1, 3, 5 min after intubation, before and after insufflation of CO₂ and during surgical procedures. Recovery profiles and postoperative side effects were assessed.

The change of MBP after intubation was significantly decreased in group EN. The change of HR after intubation and during surgical procedure were significantly decreased in group E and group R. Recovery profiles were significantly faster in all study groups compared with group C.

The use of esmolol in combination with nicardipine was effective in preventing the increase of MBP after intubation, whereas esmolol or remifentanil had attenuated the acute change of HR to noxious stimuli. Also the use of esmolol, nicardipine or remifentanil as an adjuvant to sevoflurane-N₂O anesthesia in gynecologic laparoscopic surgery had facilitated the recovery.