Under The Two Anesthetic Techniques In The Elderly Effect Of Abdominal Surgery

Objective: It is used to compare clinical materials of two types of anesthesia applied in hypogastrium operation for the aged men, and to analyze advantage and disadvantage of two types of anesthesiaMethods: 60 patients who are over 65 are selected, theses patients are operated hypogastrium operation in the general surgery dept of my hospital From December 2005 to Feb. 2011. Among them, male cases are 35, female cases are 25, and their age differs from 66 to 102. Among these, they belong to class ASAⅡ～Ⅲ. Eight cases belong to left hemicolectomy. Twenty cases belong to right hemicolectomy. Eight cases belongs totransverse colectomy. The number of Rectum miles operation cases is 10. The number of sigmoidectomy cases is 11. The number of laparoscopic resection of auxiliary operation cases is three. At the same time, the patients having chronic emphysema are six, these having high blood pressure are 55, diabetes is 12, and abnormal renal function and dysfunction of liver are 20. All patients'cases underwent selective operation.The patients are divided into two groups according to: types of anesthesia. Group A is laryngeal mask airway of compound pachymeningitis of combined anesthesia. Group B is tracheal cannula general anesthesia. The main observation index is change of MAP, HR, SpO₂, ETCO₂, as well as induction medicine sufentanil citrate injection, etomidate fat medicine of emulsion,musclerelaxant, as well as dose of active medicine of blood vessel. Choosing observation point: When the patients were calm after entering operation room (T₀),Prior to induction / hemodynamics after hemodynamics of the patient was, stable after the pachymeningitis of combined anesthesia (T₁),The exact time when Laryngeal mask airway is put in (T₂),One min the exact time after Laryngeal mask airway is put in (T₃),The time the skin is operated (T₄),It is detected in the abdomen (T₅),The average values of blood pressure / heart rate of the patient is collected per five mins in the whole process of operation (T₆),The exact time before Laryngeal mask airway is taken out (T₇),One minute after laryngeal mask airway is taken out (T₈). Patients of Group B lay silently for 5 minutes after entering operation room (T₀),Prior to induction (T₁), The exact time when Laryngeal mask airway is put in(T₂), One minute the exact time after laryngeal mask airway is put in(T₃), The time the skin is operated (T₄), It is detected in the abdomen (T₅), The average values of blood pressure / heart rate of the patient is collected per 5 mins in the whole process of operation (T₆), The exact time before Laryngeal mask airway is taken out(T₇), one minute after laryngeal mask airway is taken out(T₈). The difference between group A and Group B should be observed. (1) Puncture situation of anaesthesia. (2) The imbedding condition of laryngeal mask airway/cannula. (3) Time from entering operation room to starting operation. (4) Usage of active medicine of blood vessel and anesthesia medicine. (5) Change state of MAP, HR in operation. (6) Change state of SpO₂ ETCO₂ .(7) Time from finishing operation to time for laryngeal mask airway/ the tube was taken out, it gets better and Aldrete is valued at nine scores. (8) Adverse reaction (nausea, omitting, coughing, headache, pharyngalgia, abdominal distention)Results: Comparison between Group A and Group B (1) anesthesia puncture situation, there are 3 case of exclusion test, among three cases, two cases failed to puncture repeatedly, one case refused to cooperate in the operation, the tracheal cannula general anesthesia was adapted. Other patients successfully puncture only once. (2)the injection situation of laryngeal mask airway and tracheal cannula: patients in both groups successfully did so. After twice adjustment, one patient in group B did so, the rest patients were all injected once. (3) The time between making anesthesia and starting operation: group A is obviously longer than that of group B (P<0.05). (4) It is clear that integral dose of anesthesia is much less than that of group B(P<0.01), (5)HR at T₁ is obviously higher than that of T₀ in Group A(P<0.05). Comparing HR from T₂ to T₈ with T₁, there is no statistical difference (p>0.05). MAP at T₁ lowered obviously comparing with T₀(p<0.05). MAP at time T₂--T₈ has no significant difference contrasting with T₁ (p>0.05). HP and MAP at T₅, T₈ is obviously higher than that of T₀,T₁,T₂,T₃ and T₄,T₆,T₇(P<0.05). (6): Breathing status: there is no statistical difference in SpO₂, PETCO₂ in operation for all patients in both groups (p>0.05). (7) The time between making anesthesia and starting operation for patient in group A is longer than that of group B, however, There is no statistical difference in total period of anesthesia for patients in both groups. (8) The adverse reaction and complicating disease: occurrence of coughing and dysphoria in group B is obviously higher than that of group A. occurrence of pharyngalgia and abdominal distention in group A is obviously higher than that of group B. There are cases of lumbago and headache after operation in group A. There is no case of lumbago and headache after operation in group B. There is no omitting and aspiration in all patients in both groups.Conclusion: One, two types of anesthesia can be applied in hypogastrium operation for the aged men Two, simple tracheal cannula general anesthesia can cause extremefluctuations of hemodynamics in the process of inducing cannula and decannulation, the hemodynamics changes greatly in operation.Three, laryngeal mask airway compound pachymeningitis can reduce stimulus caused by cannula and decannulation as well as change of hemodynamics in operation. It can shorten time of taking laryngeal mask airway out and integral dose of general anesthesia usage. However, as for itself, there are many shortcomings such as it is much difficult in puncture; its applicable conditions are complicated...