The Effect Of Epidural Anesthesia Combined With General Anesthesia Under Bispectral Index Monitoring On The Anesthetic Consumption And Wake-up Time In Elderly Patients

BACKGROUNDEldly patients usually have physiological changes of ageing with a reduced organ reserve, the sensitivity to the anesthetic increase, the clearance slower, and wake up later .How to choose the adequate anesthesia remains a question.Eldly patients received epidural anesthesia combined with general anesthesia can reduce the anesthetic consumption, wake up early, removing intratracheal cannula earlier and less complication. Although the concern was initially largely one of avoiding wastage of expensive anesthetics,we have added a greater interest in the prevention of underdose and awareness. This study was to investigate the effect ofepidural blockade combined with general anesthesia under bispectral index monitoring on the anesthetic consumption of propofol, fentanyl, rocuronium and wake-up time in elderly patients.OBJECTIVETo investigate the effect of epidural anesthesia combined with general anesthesia under BIS monitoring on the anesthetic consumption and wake-up time in elderly patients.MATERIALS AND METHODSFourty ASA I～II elderly patients scheduled to undergo abdominal surgery were assigned to completely total intravenous anesthesia (group GA, n=20) or receive epidural anesthesia combined with total intravenous anesthesia (group GEA, n=20). Patients in the group GEA, 10ml of the epidural ropivacaine 0.1% was administered as a bolus followed by an infusion at 6 ml/h via the epidural catheter. Induction of anesthesia was performed with IV fentanyl 3ug/kg and propofol titrated to achieve BIS between 40～55. Endotracheal intubation was facilitated by the IV administration of rocuronium 0.6mg/kg and the lungs were ventilated with 100% oxygen. After intubation, Infusion of propofol 1% was titrated to maintain BIS between 40~55. Inadequate analgesia was treated with bolus fentanyl 0.5 — lug/kg. Neuromuscular monitoring was used toassess the need for additional doses of rocuronium. The doses of propofol, fentanyl, rocuronium required and wake-up time were recorded.RESULTSNo statistical differences were found on the demographic date and operative details between two groups (i^>0.05). There were significant decrease in SBP (P<0.05).No significant decreases on DBP, HR and BIS were found between two groups (P>0.05).The requirement of fentanyl in group GEA was smaller than group GA (P<0.05). Significant reduction was also observed in the requirement of propofol (P<0.05).The approximate requirement of rocuronium was found (P>0.05). Wake-up time were less in the group GEA than in the group GA (PO.01).CONCLUSIONEpidural anesthesia with small doses of 0.1% ropivacaine combined with general anesthesia in elderly patients can reduce the requirement of propofol and fentanyl. Wake-up earlier, removing intratracheal cannula earlier and less complication.