The Research Of Target-controlled Infusion Of Etomidate Anesthesia In Elderly Patients

Background:The eldly is increasing every year,many of which need surgical treatment. However,during anesthesia,the changes in the circulatory system often lead to cardiovascular and cerebrovascular accident.The function of the circulatory affected by the different anesthetic drugs is differently,so the choice of anesthetic drugs in old patients is particularly important.Etomidate is a short-acting,non-barbiturate intravenous anesthetic with the advantages of fast onset,action time short,wake up rapid and smooth.Etomidate has little effect on cardiovascular function and maintain a stable cardiovascular system.However,etomidate has a temporary inhibition of adrenal cortex function,so it is currently used in clinical induction of anesthesia and sedation anesthesia in outpatient surgery and is seldom used in the maintenance of total intravenous anesthesia.The application and security of etomidate anesthesia in old patients with intravenous target-controlled infusion is still lack of a large number of clinical data.The experiments are intended to explore the influence of the adrenal cortex in the perioperative through continuous monitoring of the dynamic changes of perioperative cortisol,aldosterone,adrenocorticotropic hormone concentration and hemodynamic changes,thus Evaluate the feasibility of intravenous anesthesia with etomidate target-controlled infusion in elderly anesthesia. Materials and Methods:In this experiment,forty cases of 60～75 years old,ASAⅠ～Ⅱ,elective laparoscopic cholecystectomy patients were selected.They were randomly divided into propofol group(group P,n=20)and Etomidate group(group E,n=20).To maintain anesthesia group P TCI propofol 2～4μg·ml^-1;Group E TCI etomidate 1μg·ml^-1.Both groups intermittent appended fentynal and vecuronium to maintain analgesia and muscle relaxation,maintaining P_ETCO₂ 30～40mmHg,BIS value at 40～60.Monitored Hemodynamic Changes during anesthesia and used radioimmunoassay to detect serum cortisol,aldosterone,adrenocorticotropic hormone concentrations before anesthesia(T1),and 30min(T2),2h(T3),24h(T4),48h(T5)after induction of anesthesia.SPSS11.0 version was used for statistical analysis.Measurement data was signified by mean+standard deviation((?)±s).Aanalysis of variance was used to compare the repeated measurement data within group and t test was used to compare between groups.Count data using chi-square test.Results:1.The changes of serum cortisol,aldosterone,adrenocorticotropie hormone concentration in Group Propofol and Group Etomidate:Group comparison:Group P:Cortisol,aldosterone concentration increased at T2,T3. Serum cortisol,aldosterone,ACTH concentration recoveried to the base level(T1)at T4.Group E:Cortisol and aldosterone concentration decreased at T2,T3(P＜0.05); Serum cortisol return to 72.28%of cortisol levels before induction at T4 and at T5 point back to the level before induction.ACTH concentration increased at T3(P＜0.05) and aldosterone,ACTH was basically restored to its former level at T4 point.Between the two groups:It was statistically significant difference in cortisol concentrations at T2,T3,T4 between the two groups(P＜0.05).And aldosterone, ACTH concentration was statistically significant difference at T2,T3(P＜0.05).2.Hemodynamie changes in Group Propofol and Group Etomidate:Immediately before intubation:comparison with the pre-anesthesia,SBP,DBP, MAP reduction,HR slowing in Group P(P＜0.05).SBP,DBP,MAP,HR was no significant difference comparison with the pre-anesthesia in Group E(P＞0.05),but HR was significantly higher than propofol group,the difference was statistically significant(P＜0.05).SBP,DBP,MAP,HR was no significant difference in each other time point between the two groups(P＞0.05).Conclusion:1.Etomidate intravenous target-controlled infusion can effectively inhibit the stress response of laparoscopic cholecystectomy in old patients and maintain hemodynamic stability.2.The inhibition of adrenal cortex by etomidate intravenous target-controlled infusion for anesthesia maintenance is more than propofol,but cortisol has basically retumed to the level before anesthesia after 48h.3.Etomidate intravenous target-controlled infusion can be safely used in elderly patients with laparoscopic cholecystectomy anesthesia.