The Comparison Of Effect Of Two Methods Of Anesthesia In Major Liver Resection

Objective:To compare the effects of two anesthetic techniques in major hepatic by the amounts of intravenous anesthetic agents and vecutonium,heart(HR),mean arterial pressure(MAP)and the time of stopping propofol to extubation.Methods: Fifty-eight patients who were undergoing elective major liver resection were randomly divided into two groups:intubation total intravenous anesthesia group(groupⅠ)and combined general-epidural anesthesia group(groupⅡ).In combined general-epidural anesthesia group epidural puncture was performed at T_8-9or T_9-10.After catheter was fixed,2%lidocaine 4ml were infused into epidural,when the epidural anesthesia was working the general anesthesia was induced.In both groups,anesthesia was induced with midazolam,vecuronium,fentanyl and maintained with propofol.Vecuronium was given when necessary.In combined general-epidural anesthesia group,before skin incision 1% ropivacaine(50mg)was given through epidural catheter and the same dosage was given in every 2 hours.The total volumes of ropivacaine were recorded.In the groups, electrocardiogram,non-invasively arterial pressure,arterial oxygen saturation,airway pressure and urine production were monitored continuously.Fentanyl and vecuronium were stopped 30 minute before the end of operation.Propofol was stop when closing peritoneum.Total volumes of propofol,fentanyl,vecuronium and operation's times, times of stopping -propofol to extubation and whether having awareness at interoperation,whether having pain were all recored in both groups.Results:In both groups none of patient has awareness and pain.The amounts of fentanyl,vecuronium, propofol and the cost in total intravenous anesthesia group were significantly higher than combined general-epidural anesthesia group(P＜0.05),the time of stopping-propofol to extubation is also longer than it(P＜0.05).In the combined general-epidural anesthesia group,the change of MAP during operation is insignigicant compare to baseline,but it increase significantly in the total intravenous anesthesia.Conclusions:Combined general-epidural anesthesia in hepatectomy can decrease the amount of fentanyl, vecuronium and propofol and more stability of hemodynamic,earlier extubation,more safety and economy.