Influence Of Combination Of General And High Thoracic Epidural Block On Stress Response Of Patients Undergoing Radical Mastectomy During Anesthesia And Operation

Objective To observe the effects of combined general and high thoracic epidural block on stress response in perioperative patients undergoing radical mastectomy.Methods Twenty-four female patients scheduled for modified radical mastectomy were randomly divided into 3 groups : combind general and high thoracic epidural block(group Combination , n=8),continuous high thoracic epidural block(group EA,n=8)and inhalational general anesthesia(group GA,n=8).In combined anes- thesia group (group C)epidural blockade at T2 ,3 or T3,4 was firstly performed with 1.2% lidocaine, 0.15% tetracaine and 2.5μg·ml-1 fentanyl during operation. After reaching the blockade of C6～T6, general anesthesia was rapidly induced with midazolam 0.05mg.kg-1,fentanyl 1μg·.kg-1 ,propofol 2mg·kg-1 and scoline 1.5mg·kg-1 and mentained with Isoflurane in oxygen and Vecuronium.Group GA was not received epidural anesthesia and others were same as group C. EA group was not received general anesthesia and others were same as group C. Epinephrine(E)levels were measured with ELISA(enzyme—linked immunosorbent assay).The levels of Cortisol(COS),Grown hormone(GH),Prolactin(PRL)and Adren-ocorticotropic hormone(ACTH)were detected with radioimmunoassay.4ml of peripheral venous blood samples was taken before anesthesia (T1),at the beginning of surgery(T2)and the end of surgery(T3).Result: the levels of E decreased insignificantly at T2(p<0.05)in group C but increased insignificantly at T2(p<0.05)both group EA and group GA, increasing insignificantly at T3 in group GA(p<0.05).Compared with T1 ,the levels of PRL increased insignificantly at T2 and T3(p<0.05)among the three groups as well as there were no significantly difference among the three groups. Compared with the other two groups, the levels of E in group C decreased insignificantly at T2(p<0.05); compared with group GA , the levels of E in group C decreased insignificantly at T3(p<0.05); Compared with the other two groups, the levels of ACTH in group C decreased insignificantly at T3(p<0.05);The levels of COS were no significantly difference at three time among the three groups.