Study Of Different Dose And Concentration Levobupivacaine Epidural Anesthesia Combined With General Anesthesia Modulated By Entropy To Upper Abdominal Sugery

Objective:To compare the effects of epidural anesthesia with different dose and concentrition levobupivacaine combined with general anesthesia modulated by entropy to upper abdominal sugery on general anesthesia drug requirements,haemodynamic variables, stress hormone response and wake-up time after operation, to provide evidence for the choose of suitable anesthesia ways for the upper abdominal sugery.Methods: Forty ASA classⅠ-Ⅱpatients aged from 20 to 60 years old for upper abdominal sugery were included in this study.Patients with significsant cardiorespiratory disease were excluded. According to the epidural treatment, patients were randomly distributed into four groups.Group A received epidual 6ml 0.25% levobupivacaine+prpofol and sevoflurane anesthesia.Group B received epidual 6ml 0.5% levobupivacaine+prpofol and sevoflurane anesthesia. Group C received epidual 9ml 0.5% levobupivacaine+prpofol and sevoflurane anesthesia. GroupD received epidual 6ml 0.75% levobupivacaine+propofol and sevoflurane anesthesia.There are10 cases in each group.After sterilization,an epidural puncture was carefully performed a 18-gauge at the T8-9 intervertebral space using a median approach in the left lateral flexed position. A catheter was inserted into epidural space in a cephaled direction for 3㎝.The patient was the placed supine.A test dose of 3 ml 2% lidocaine was given to exclude intrathecal position.An intubation was done after rapidely anesthesia induction,then the patients were given mechanical ventilation carried out,with tidal volume 10ml/, frequency 10 min-1and oxygen flow 1L/min. Propofol and sevoflurane was injusted to achieve a target entropy 40-60 during maintenance of anesthesia.Measurements include the herat rate (HR),mean artery pressure (MAP),inspired and end-tidal sevoflurane concentrations; state entropy and response entropy before epidural anesthesia,before anesthesia induction, after anesthesia induction,at the time of endotracheal intubation, at the time of skin incision, exploration, the peritoneum was sutured. Following recovery from anesthesia,the patients were questioned about explicit recall of intraoperative events,and the interview was repeated within 5h on the ward and the next day.Results:Group B,C and D showed lower MAP during operation when compared with Group A. Besides, Group B showed less variable values of MAP during operation when when compared with other groups.The requirement of general anesthesia drug in Group B,C and D is lower than Group A.None of the patients had recall of intraoperative events.The increase of plasma glucose concentrations and cortisol concentration from T1 point to T2 point and from T1 point to T3 point in Group B,C and D is lower than Group A (p < 0.05) .However,the difference between Group B,C and D was not statistically significant.The time to orientation was faster in Group B compared to the other groups.Conclusions: To maintain SE and RE value during combined epidural/general anesthesia for upper abdominal sugery, 6ml 0.5% levobupivacaine epidural anesthesia combined with propofol and sevoflurane showed lower and less variable values of MAP, reduced propofol and sevoflurane usages, attenuate the plasma levels of cortisiol and blood glucose and can shorten the wake-up time.So this Type of anesthesia is a suitable anesthesia on abdominal surgery.