General Anesthesia Combined With Epidural Anesthesia For Abdominal Surgery In Elderly Patients With Hemodynamic Effects Of Blood

Objective:Analyzing hemodynamic changes of the elderly receiving abdominal surgery under general anesthesia combined with epidural anesthesia. Aim to offer a better choice to surgery treatment for the elderly in a safe and effective way.Methods:The patients were eligible and enrolled who were to undergo abdominal surgery in the period of November 2009 to March 2010, in the First Affiliated Hospital of Dalian Medical University. Preoperative cardiac function is 1-3 NYHA class. Exclusion criteria included a history of heart disease, hepatic, renal, or psychological disease, allergy to narcotics, and a contraindication to an epidural catheter. Patients were randomly divided into two groups, L group:age>65 yr; Y group:age<65 yr. Observe MAP, DBP, SBP, HR, CVP, SpO2, PetCO2, CO, SV, TFC, ACI, SVR in baseline, after induction of anesthesia, at the time of trachea intubation,5 minutes, 20 minutes,35 minutes and 1 hour after skin incision respectively, and the time of trachea extubation. Compare differences of the hemody-namic changes between the two groups and in the L group respectively.Results:1. Blood pressure:After induction of anesthesia, the blood pressure of the L group is lower than baseline. No significant differences between the two groups.2. Stroke volume (SV):The L group's is lower than that of the Y group each time period, except the time of trachea intubation. 3. Cardiac output (CO), thoracic fluid content (TFC):In the course of the anesthesia, there is no significant difference between the two groups with CO and TFC.4. Acceleration index (ACI):The baseline of the L group is lower than the Y group'. After anesthesia, the two group is not different This index presents a downward trend in the L group.5. Heart rate (HR): The HR of the L group increased more than the Y group when 20 minutes and 1 hour after skin incision. There is no significant difference in the L group.6. Systemic Vascular Resistance (SVR):after anesthesia, no significant difference between the two groups. The SVR of the L group decreased significantly at the time of induction and 20 minutes after skin incision.Conclusion:This study showed that general anesthesia combined with epidural anesthesia for the elderly has a negative impact on their circulatory system, particularly in the most significant 20 minutes after incision. CO can be maintained properly suggests that this anesthetic method not seriously inhibit the myocardial contractility of the elderly and is relatively safe and effective.