The Clinical Observation Of Different Concentration Ropivacaine Epidural Anaesthesia Combinated With Target-controlled Infusions Anaesthesia In The Elderly Colorectal Cancer Surgery

Objective : To compare the efficacy of epidural anaesthesia with three different concentration ropivacaine in combination with target‐controlled infusions (TCI) of propofol anaesthesia in Coloretal cancer Surger for the elderly, we compared them with hemodynamics, drug consumption, postoperative awakening. Choose a suitable combination, and provide a reference for clinical .Methods:Sixty patients ,ASA physical status I–II, aged 65～80 years, scheduled for elective Colorectal cancer Surgery ,were randomly divided into four groups: Group I:received epidural normal saline(NS)+ target-controlled infusion (TCI) ; Group II:received epidural 0.2% ropivacaine+TCI;GroupⅢ:received epidural 0.375% ropivacaine+TCI; GroupIV:received epidural 0.5% ropivacaine+TCI. We selected L1～2 intervertebral space as the puncture site of epidural anesthesia and used 1% lidocaine 3ml as the test dose, then the appropriate concentration of ropivacaine 5ml was injected via the epidural catheter ,adjusting the anesthesia level to below T6-8, epidural dosing ropivacaine with 5ml.h-1 constant speed infusion by pump. We use propofol target concentration 3.0μg.ml-1 and remifentanil concentration 2.5ng.ml-1 as intravenous anesthesia induction. Intraoperative maintain propofol target concentration 3.0μg.ml-1 and remifentanil concentration 1.0～6.0 ng.ml-1.The blood pressure, heart rate and CVP were recorded at the time of preanesthesia, the maxlmum plane of epidural block, the induction of general anesthesia, intubation after 1min, intubation after 5min ,incision , surgical exploration, close abdominal, sewing leather, the end of operation and open eyes. Observed in each group postoperative recovery status. All the patients were questioned about explicit recall of intraoperative events, and interview was repeated on the next day.Results: 1. The MAP of each group after epidural block was no significant difference compare with the preanesthesia period MAP(P> 0.05). The time of immediately before intubation ,MAP of each group were decreased , there was significantly difference compare with the baseline(P <0.05 ), 5 patients in the group IV and 1 patient in other groups MAP decreased> 30%. Each time point of MAP on intubation after 1min, intubation after 5min, skin incision, surgical exploration, close abdominal, sewing leather, the end of operation and open eyes, compared with the group I, smaller change of MAP in group of III, IV, there was significant difference ( P <0.05), group II was no significant difference (P> 0.05) compare with group I. Group III, IV maintain with a lower mean of MAP during intraoperative, compared with the group I there were significantly different (P <0.05).2. The HR of each group there no significant difference between (P> 0.05). 3. The target concentration of remifentanil maintain infusion of each group was significantly different between (P <0.05).4. The time of recovery from anesthesia of each group was no significant difference between (P> 0.05),and group III, IV awake for better quality.5. None of a patient reported awareness during intraoperativeConclusion:1. Epidural anesthesia combined with propofol target-controlled anesthesia in elderly patients, can reduce the stress response of anesthesia induction ,provide surgery in the maintain hemodynamic stability , also can avoid the occurrence of intraoperative awareness.2. In the elderly patients,0.375% ropivacaine epidural anesthesia combined with general anesthesia , with propofol target concentration 3.0μg.ml-1, remifentanil target concentration 2.5ng . ml-1 maybe a suitable combination anesthesia technique , can save applicated in Lower abdominal surgery.3. Ropivacaine epidural anesthesia combined with general anesthesia does not affect the time of Anesthesia recovery , can improve the quality of postoperative recovery.