Effects Of Different Anesthetics Combind With Epidural Anaesthesia On Stress Reaction Of Patients Undergoing Operations Of Esophageal Cancinoma

Background:For majority patiens of esophagectomy in elderly,their immune function and compensatory function are less,but complications are more.One-lung ventilation (OLV) technique is increasingly being used for the radical correction of esophagus carcinoma.But,Thoracic Surgery or One-lung ventilation(OLV) induces strongly stress response and a pro-inflammatory response including cytokine release,leucocyte recruitment and stress reaction hormone release in the ventilated lung.These respons would induce the changes of respiratory system,circulatory system,nerves-endocrine -immune system(NEI).The majority pations of malignant tumor exist immune disfunction.Stress reaction induced by operation would lead to immune function decrease,that would result in survival rate of cyto-microembolus increasing. These would lead to tumor cell growth and tumor metastasis.Even though stress reaction major induced by operation stimulus,but suitable compatibility of anesthetic drugs or methods are benefit for controling stress reaction during operation and improving pations immune state.Remifentanil is a relatively newμ-opiate receptor agonist and the first super-short-potency opioid drug.The stable elimination rate of remifentanil fit in the liver or kidney dysfunction and the elderly population for a long time anthesia without having to consider the problem of drug infusion accumulation.But,there are a few problems during anesthesia with remmifentanil.The inhibitory effect of anaesthetic agents on stress response may depend upon their dose,especially when using a i.v.or volatile agent.Intraoperative and postoperative inhibition on heart function inhibition due to high-dose remifentainil or sevoflurane would lead to the complication induced: bradycardia,low cardiac output,fluctuation of hemodynamics,muscle of thorax becoming stiff,and so on.The other problem is that pain rise at postoperative earlier period.This kind of pain would indue strong stress response.These all are adverse effects to patiens of esophagectomy in elderly.Scholars at home and abroad have launched lots of comparative study to stress respons during thoracic surgery.At present,we recognized that:general anesthesia combined with epidural anaesthesia have the more inhibitory effects to stress respons than general anesthesia.However,many of these studies are based on single-cavity intubation anesthesia.There are few studies on patients undergoing esophagectomy with OLV anesthesia.Furthmore,comparative study about i.v.vs volatile has not been reported.ObjectiveThe purpose of this randomized open study was to compare the effects of remifentanil and sevoflurance combined with epidural anaesthesia to stress reaction during one-lung ventilation,as primary anaesthetic agents,in order to approaching the better anesthesia methods that having minimum influence to pations,improving near and long term operation effectiveness,and providing theoretical bases for rational administration during clinical anesthesia.methodsFourty patients(ASA plysial statusⅠ～Ⅱ) receiving radical correction of esophageal carcinoma were randomly divided into 2 groups:Remifentainil with epidural anaesthesia group(R,n=20) and Sevoflurane with epidural anaesthesia group(S,n=20).Left-sided double lumen tube were all performed in group R and S during OLV.In group R,pations were anethetized with remifentanil(0.05～0.1μg/kg/min ),while in group S,were anethetized with sevoflurane(1%～2%).The mixed venous blood samples were measured by radioimmunoassay(RIA) technology before anesthesia(T0),at two-lung ventilation 10min(T1),one-lung ventilation 40min(T2).one-l ung ventilation 90min(T3),renew two-lung ventilation 20min(T4).Haemodynamic index was continuous monitored during operation.And record SPO₂,P_ETCO₂,PAW,the time used of surgery,volume of bleeding,fluid infusion and urine volume,and according to the specific circumstances of the additional anesthetics and doses, auxiliary substances such as atropine and ephedrine and the times.Statistics analysisAll data is used SPSS 11.5 for statistical analysis,and all measurement data are present by mean±standard deviation((?)±s),and the statistical methods uses analysis of variance,the minimum significant difference(LSD) t-test,countable data use chisquare test.The significance test criterion is a=0.05.Results1.General situationThere were no statistical differences in age,gender,weight,operation time,the volume of blood loss,anesthesia induction,analepsia time,fluid replacement,urine volume,aid-Medicationand(atropine,ephedrin,Urapidil,esmolol),and postoperative complications among group Rand S(P＞0.05).2.Index of hemodynamicThere was no significant difference at T0 in HR,SDP,DBPamong group Rand S or within group comparison(P＞0.05).The SBP at T2(115.7±6.8) mmHg in R group were lower than that at T0 (126.1±11.6),T1(110.1±10.4)mmHg in S group were lower than that at T0(119.3±11.4)mmHg(P＜0.05).The SBP at T2(128.9±11.5)mmHg were higher than that at T0 in S group(119.3±11.4)mmHg(P＜0.05). The value of SBP at T1(110.1±10.4)mmHg in S group were lower than that in R group(123.4±10.2)mmHg(P＜0.05).The value of SBP at T2 in S group(128.9±11.5)mmHg were higher than that in R group(115.7±6.8)mmHg(P＜0.05).The DBP at T1 were lower than that at T0 in S group(P＜0.05).The value of DBP at T1(66.9±8.7)mmHg in S group were lower than that in R group(72.7±7.2)mmHg(P＜0.05).The value of DBP at T2 in S group(66.9±8.7)mmHg were higher than that in R group(73.2±6.6)mmHg(P＜0.05).3.S_PO₂ AND P_ETCO₂There was no significant difference at each moment in S_PO₂ AND P_ETCO₂ among group Rand S or within group comparison(P＞0.05).4.Triiodothyronine(T₃),thyroxine(T₄),Tumor Necrosis Factor(TNF-a),interleukin(IL-10),Thyroid-Stimulating Hormone(TSH)4.1 Within group comparison:TheT₃atT2(2.10±0.36)ng/ml,T3(1.90±0.15)ng/ml,T4(1.58±0.39)ng/ml were lower than that at T0(2.26±0.38)ng/ml in R (P＜0.05).The T₃ at T4(2.02±0.34)ng/ml decreased than that at T0 in S group(P＜0.05).There was no significant difference at the rest moment in the values of T₃(P＞0.05).Group comparison:The values of T₃ at in S group T3(1.90±0.15)ng/ml,T4(1.58±0.39)ng/ml were higher than those in R(2.18±0.22)ng/ml,(2.02±0.34)ng/ml(P＜0.05).There was no significant difference at the rest moment in the values of T₃ during R and S group(P＞0.05).4.2 Within group comparison:The T₄ at T4(95.25±18.28)ng/ml were lower than that at T0 in R(112.43±22.45)ng/ml(P＜0.05).The T₄ at T2(153.45±17.21)ng/ml,T3(148.62±21.11)ng/ml,T4(122.86±18.33)ng/ml were lower than that at T0 in S group(113.57±22.86)ng/ml(P＜0.05).There was no significant difference at the rest moment in the values of T₄(P＞0.05).Group comparison:The values of T₄ at T2(153.45±17.21)ng/ml,T3(148.62±21.11)ng/ml,T4(122.86±18.33)ng/ml in S group were higher than those in R T2(100.23±17.15)ng/ml,T3(111.00±15.54)ng/ml,T4(95.25±18.28)ng/ml(P＜0.05). There was no significant difference at the rest moment in the values of T₄ during R and S group(P＞0.05).4.3 Within group comparison:The TSH at T1(2.40±0.55)MU/L were lower than that at T0(3.04±0.60)MU/Lin R(P＜0.05).The TSH at T3(3.50±0.51)MU/L were higher than that at T0(3.14±0.07)MU/L in S group(P＜0.05).There was no significant difference at the rest moment in the values of TSH(P＞0.05).Group comparison:The values of TSH at(3.00±0.75)MU/L,(3.50±0.51)MU/L in S group were higher than those in RT2(2.88±0.58)MU/L,T3(2.72±0.72)MU/L(P＜0.05).There was no significant difference at the rest moment in the values of TSH during R and S group(P＞0.05).4.4 Within group comparison:The TNF-a at T2(0.21±0.02)μg/ml,T3(0.32±0.02)μg/ml,T4(0.47±0.10)μg/ml were higher than that at T0(0.18±0.04)μg/ml in R(P＜0.05).The TNF-a at T1(0.34±0.06)μg/ml,T2(0.42±0.12)μg/ml,T3(0.50±0.09)μg/ml,T4(0.63±0.04)μg/ml were higher than that at T0(0.17±0.02)μg/ml in S group(P＜0.05).There was no significant difference at the rest moment in the values of TNF-a(P＞0.05).Group comparison:The values of TSH at T1(0.34±0.06)μg/ml,T2(0.42±0.12)μg/ml,T3(0.50±0.09)μg/ml,T4(0.63±0.04)μg/ml in S group were higher than those in RT1(0.18±0.04)μg/ml,T2(0.21±0.02)μg/ml,T3(0.32±0.02)μg/ml,T4(0.47±0.10)μg/ml(P＜0.05).There was no significant difference at the rest moment in the values of TNF-a during R and S group(P＞0.05).4.5 Within group comparison:The IL-10 atT3(39.40±12.4)pg/ml,T4(53.1±17.2)pg/ml were higher than that at T0(20.8±6.8)pg/ml in R and that at T3(31.7±12.2)pg/ml,T4(40.5±14.5)pg/ml were higher than that at T0(22.7±7.0)pg/ml in S group(P＜0.05).There was no significant difference at the rest moment in the values of IL-10(P＞0.05).Group comparison:The values of IL-10 at T3(31.7±12.2)pg/ml,T4(40.5±14.5)pg/ml in S group were lower than those in R T3(39.40±12.4)pg/ml,T4(53.1±17.2)pg/ml(P＜0.05).There was no significant difference at the rest moment in the values of IL-10 during R and S group(P＞0.05). Conclusion:1.Remifentainil or Sevoflurane with epidural anaesthesia had similar effect on haemodynamics during OLV.But the maintaining anesthesia with remifentanil were gender than that with sevoflurane to elderly patients with esophageal cancer.2.Remifentainil with epidural anesthesia compared to sevoflurane with epidural anesthesia can control more effectivly the level of stress response during OLV, and is suitable for the elderly patients with esophageal cancer.