Effects Of Propofol And Sevoflurane For General Anesthesia On The Recovery Of Quality Of Awakening In Elderly Hip Surgery Patients

Objectives: To compare the effects of propofol and sevoflurane for general anesthesia on the Quality of awakening in elderly patients in the early postoperative period.Methods:1 Research objectives: Sixty ASAⅡ～Ⅲpatients(32 males (and) 28 females ) .The youngest was 65 years of age, the oldest 82,Weighting 45-86kg Height 150^-181cm And hypertension 20 examples, diabetes 11 examples, symptomless brain stem dead sequela 2 examples.Exclusion criteria included Mini-Mental State Examination (MMSE) score < 24 points, Neurological cardiac or metabolic disease, Chronic renal failure and active liver disease, Long-term use of sedative drugs or antidepressant drugs, lliteracy or can not effectively communicate that and incapability implement the tester of whole processeses with mental doctor on the language .2 Preoperative preparation: Sixty ASAII or III elderly patients undergoing orthopedic surgery under general anesthesal were randomly assigned to two groups (n=30 each). Group S sevoflurane and group P propofol . By the patients before the surgery to understand the general situation including the situation of education, and other chronic diseases, TO make the MMSE test scores, and made the relevant explanation.Patients fasted overnight.Before the induction of anesthesia, a freely running intravenous infusion should be established, all monitoring devices should be in a place and the baseline values should be recorded. Monitoring end-tidal concentration of sevoflurane.3 Induction of anesthesia: Patients received the same medicine with midazolam 0.05¹mg/kg,fentany 2⁴ug/kg perior to induction of anesthesia,Emptying storage bag and oxygen flow adjusted to 6L/min, sevoflurane vaporizer adjusted to 6%, pre-charge sevoflurane 45s , Made air storage filling up. Asked patients to take a deep breath, after the patient had made a maximal expiratory, fasten the face mask. Loss of consciousness was defined as both the loss of the eyelid reflex and a lack of response to the verbal command,.Intermittent intravenous injection cisatracurium 0.3 mg.kg^-1. Endotracheal intubation for rapid induction. Intermittent intravenous injection of both groups in the cisatracurium 0.15 mg.kg^-1 to maintain the degree of muscle relaxation in surgery.4 Intraoperative management: Anesthetic was maintenanced with Inhalation of sevoflurane combined with remifentanil intravenous. Inhalation of end-tidal sevoflurane concentration to maintain the gas concentration in the 1 2 MAC (group S) and group P anesthesia was maintained by intravenous injection of remifentanil ( 0.20¹Î¼g.kg^-1.min-1 and propofol (4⁸mg·kg^-1h^-1) intermittent iv boluses of cisastracurium And anesthesia maintain systolic blood pressure(SBP),diastolic blood pressure(DBP),heart changes range rate 20% compared with the basieline. When blood loss greater than 500ml, the timely infusion of packed red blood cells. If intraoperative mean arterial pressure increase or decrease by more than 20% of the basic values, group S first increase or reduce sevoflurane concentration of inhaled, P group first increase or reduce propofol input speed .If mean arterial pressure (MAP) above the basic value 20%, intravenous injection urapidil 15mg each, if mean arterial pressure (MAP) below 20% based, intravenous injection methamphetamine 10mg each,When the heart rate is lower than for 50 times per minute . intravenous injection atropine 0.3 ¹mg, If the heart rate higher than for 120 times per minute, intravenous injection esmolol 20mg. 30 minutes before the end of surgery stop injecting muscle relaxants。When it comes to suture the wound ,Stop using sevoflurane or propofol; The end of the suture the wound, the remifentanil infusion disabled.5 The Indications of extubation : The patients heared clearly verbal instructions and responded, Eye opening, Spontaneous breathing frequency of 16 25, tide volume 350 ml or more and wiithout oxygen no less than 90% when the SP02.The time for spontaneous breath,eye opening and extubation after the operation were recoded. A visual analog scale (VAS) was used to assess postoperative pain . Postoperatively patients rated their pain (0¹0) at 24 and 48h. Pain intensity was divided into 0¹0 points, 0 into painless, 10 into in great pain. Postoperatively patients had accesss to a fentanyl PCIA for 48h.PCIA included a bolus of 2ml with a 15min lockout.The patients'cognitive functions of pre—operation and 12h,72h after extubation was measured MMSE method. Simple intelligence state examination of normal and abnormal separation by education degree value and relevant; Illiteracy group affected by 17 points; The primary school (Time education < 6 years) by 20 points,Secondary school or above (Time education > 6 years) by 24 points.Results:1 The time for spontaneous breath,Eye opening and extubation had no different.2After 24h group P and group S were 6 cases and 4 patients MMSE score less than 24, 72h after the scores were > 24 points.3Both groups can infect cognitive function in the elderly patients in the early postoperative period. There were similar tendency of the MMSE score changes.MMSE scores were significantly reduced in both groups at 12h after operation, The MMSE scores at 72h in both group returned to baseline,but one patient in group P still had POCD.Conclusions:sevoflurane and propofol to drop after old age hip department surgery anaesthesia early cognition function, 3 days later restores normally, There was no significant difference on the recovery of Quality of awakening between two medicines.