Comperision Of Intravenous Anesthesia Combined With Continuous Epidural Anesthesia And Total Intravenous Anesthesia

ForewordStress response to surgery occurs during the whole peri-operative period. Various stress stimuli include preoperative emotional tension, fear and anxiety , surgical trauma and pain, change of blood volume , and postoperative complications of pain and infection, among these the stress of tracheal intubation and surgical trauma is most severe. Stress may result in a series of change in circulation, endocrine, metabolism and immunity, while severe stress may change the homeostasis , increase oxygen consumption and cardiac performance, and cause arrhythmia, hypercoagulation, and inhibition of immunity, so as to increase peri-operative complications and mortality rate.Reasonable application of anesthesia technique and anesthetics can effectively reduce harmful stress response. Many studies have verified that epidural anesthesia can effectively alleviate stress response to lower abdominal surgery, but it can not effectively alleviate stress response to upper abdominal surgery. Intravenous anesthesia or inhalation anesthesia can not decrease the secretion of stress hormone and the occurrence of myocardium ischemia., while the decrease of blood pressure is considered to be related with the inhibition of myocardial function by deepening of anesthesia., so there is limitation to reduce stress response simply by increasing the concentration of inhalation anesthetics or the dosage of intravenous anesthetics,they can even increase the danger of myocardium ischemia in some patients. Generally, it is realized that stress response is relatively mild in balanced anesthesia. Opioids can effectively alleviate the secretion of stress hormone and hemodynamic changes.In previous studies of inhibition of peri-operative harmful stress response by combination of epidural anesthesia with general anesthesia, the intravenous anesthetics were introduced by artificial injection or continuous infusion by ordinary micro-pump only, so it can not to provide a stable blood concentration of drug .TCI is an advanced anesthesia technique by using intellectual drug infusing apparatus to attain the target drug concentration designed by doctor rapidly(i.e. the blood concentration and the effective regional concentration of drug)., and it can be regulated according to clinical requirement, so as to provide a relatively stable blood concentration of drug. This study is to investigate the application of epidural anesthesia combined with TCI of propoful, sufentani and vecuronium intravenous anesthesia in upper abdominal operation.ObjectTo observe the application of continuous ropivacaine epidural anesthesia combined with intravenous anesthesia with plasma concentration control infusing of propofol. sufentanil and vecuronium in upper abdominal surgery.MethodThirty-two patient undergoing selected upper abdominal surgery. ASA â…  â…¡, age <65 year, with normal cardiac, lung, hepatic, renal function, excluding patients with massive bleeding, hypothermia and other accident requiring urgent management in operation, were randomly allocated into one of two groups: Group E1VA received 0.375% ropivacaine 5 ml per hour continuous epidural infusion combined with intravenous anesthesia with propofol .sufentynl and vecuronium by plasma concentration controlled infusion ;Group TIVA received only intravenous anesthesia with propofol , sufentynl and vecuronium by plasma concentrationcontrolled infusion. Plasma concentration of propofol was regulated according to BIS value which was maintained at around 50. Plasma concentration of vecuronium was regulated according to TOF value of muscle paralysis monitor, witch was maintained below 25. The concentration of vecuronium was increased with body movement or hiccough. Plasma concentration of sufentynl was regulated to maintain SBP/DBP(MBP) and HR ranged from 80%-120% of baseline by vasoactive drugs. SBP/DBP(MBP) and HR were observed at the time before anesthesia (T₀), unconsciousness (T₁), intubation (T₂), 2 min after intubation(T₃,), 2min after incision (T₄), peritoneal cavity exploration (T₅),1.0 h after incisio...