A Clinical Study Of Target Controlled Infusion Propofol Combined With Epidural Anesthesia During Radical Gastrectomy In Patients With Gastric Cancer

Objective To evaluate the effect of target controlled infusion propofol combined with epidural anesthesia on the circulatory function, electroencephalograph, stress response during radical gastrectomy in patients with gastric cancer.Methods Thirty patients with gastric cancer ,ASA grade Ⅰ- Ⅱ ,were divided randomly into target controlled infusion propofol /fentanyl group(group T) and target controlled infusion propofol combined with epidural anesthesia(group T+E).In both groups anesthesia was induced with fentanyl 3 μ g/ml,propofol by TCI with 4 μ g/ml,succinylcholine 2mg/kg,and was maintained with propofol by TCI 2-6 μ g/ml according to the effect site concentration.In group T+E epidural was performed at T8-9 and epidural catheter was placed and 0.5% ropivacaine was given before induction of general anesthesia.Hemodynamics and electroencephagram were monitored and intraoperative awareness,postoperative,restlessness ,anesthetic dosage and time for emergence and orientation were recorded.also the concentrations of blood glucose, serum insulin, cortisol, interleukin-6, and plasma glucose were determined at pre-operation, induction,skin incision,exploration and end of the surgery.Results (1) Total dose of propofol was statistically lower in groupT+E than that group T (P<0.05 ) ,same was the stardardized unit dose of propofol,postoperative restlessness in group T+E signifisantly lower than in group T. The awakening time in two groups were similar (2) BIS and SEF levels in both groups from induction to surgery over were significantly lower than those in pre-induction,but there were unsugnificantly between groups during whole procedures.(3)Blood pressure in both groups after induction were signifisantly lower than in pre-induction, DBP in group T+E after induction were signifisantly lower than in group T, Thehemodynamics in group T+E was more stable than that in group T at exploration after surgery and extubation.(4)Blood glucose increased during operation and peaked at end of the surgery .The increase in blood glucose was significantly greater in group T than in group T+E after surgery. Cortisol levels decreased from the baseline to early of the surgery in both groups. The increase in cortisol was significantly greater in group T than in group T+E after surgery. Serum interleukin-6 levels increased significantly during operation in group T and peaked at end of the surgery in both groups, The increase in Serum interleukin-6 was significantly greater in group T than in group T+E after surgery. There was no significant changes in insulin and glucagon.Conclusions target controlled infusion propofol combined with epidural anesthesia during radical gastrectomy in patients with gastric cancer has the advantages of less propofol ,rapid awakening,less postopertive restlessness and stress response ,more stable blood pressure and easier adjustment of depth of anesthesia. It is a good method for clinical anesthesia.