The Study Of Sevoflurane Combined Remifentanil Target Controlled Infusion In Elderly Cancer Patients Clinical Anesthesia

Objective:The object of this research is to compare the hemodynamics indexes and postoperative eye opening and extubation time between sevoflurane combined remifentanil and propofol combined with remifentanil in elderly tumor patients during anesthesia period; study the application value of sevoflurane combined remifentanil target controlled infusion (target controlled, infusion, TCI) in the clinical anesthesia in elderly tumor patientsMethods:We choose112cases of gastric cancer elderly patients who underwent operation by general anesthesia, All of subjects were65-79years old, and Ⅰ-Ⅱ grade according to ASA classification. Subjects were given oxygen inhalation and the monitor were connected after the patients into the operating room for monitoring ECG、blood pressure and finger pulse oxygen saturation. And then establish lower limb venous access, line of radial artery puncture for monitoring systolic blood pressure (SP), diastolic blood pressure (DP),arterial pressure(MAP). The patients’s basal blood pressure, heart rate (HR), respiratory rate (RR), pulse oxygen saturation(SPO2)and the bispectral index (BIS value) were measured after all indicators were stable. Then the induction of anesthesia was started. The two groups of patients were used the same induction of anesthesia method. After intravenously midazolam2mg, subjects were induced by target controlled infusion (TCI211type), remifentanil TCI(plasma target concentration)3ng/ml, propofol TCI(plasma target concentration)3μg/ml. when the bispectral index (BIS value) is60,we injected cisatracurium drugs by four ED95. After muscle relaxation, we conducted tracheal intubation and mechanical ventilation. Respiratory frequency was12/min. The tidal volume was10ml/kg. The ratio of breath and expiration was1to2. Inhaling sevoflurane concentrations and end tidal carbon dioxide (PETCO2) were detected by Datex anesthetic gas monitor. After induction of anesthesia, in S group, target controlled propofol infusion were stopped and sevoflurane was began to inhaling, While the P group was continued to infuse propofol. Keep remifentanil TCI(plasma target concentration)3ng/ml,ensuring the bispectral index (BIS value)was40-60. Half an hour before the end of surgery to stoped using cisatracurium drugs. When the peritoneum was closed, intravenous fentanyl2μg/kg.5minutes before the end of surgery to stop using drugs.The changes of heart rate, systolic blood pressure(SBP), diastole blood pressure(DBP) and double exponential (RPP) value were observed at the time points of before induction(T0), incision(T1), when the end of surgery(T2), extubation(T3). At the same time, observed the patients’s maximum value, minimum value of blood pressure, heart rate, the bispectral index (BIS value), eye opening time and extubation time. Results:1. There was no significant difference between age, weight, gender, type of operation, average operation time of the two groups.2. Cardiovascular parameters2.1. The systolic blood pressure, diastolic blood pressure, MAP at T0, T1, T2, T3of the two groups was no significant difference (P>0.05). There was no significant difference between the minimum and maximum intraoperative systolic, diastolic, MAP, HR, RPP of the two groups.2.2Compared with T0, the systolic, diastolic, MAP, HR of T1, T2, T3was not statistically significance in the two groups (P>0.05).3. Recovery and restoration in the two groupsCompared with the P group, the patients in S group were less eye opening and extubation time.(P<0.05)Conclusion:Both remifentanil combined with propofol and remifentanil combined with sevoflurane have good clinical effect and safety. But the speed sober time of remifentanil combined with sevoflrane is short. So sevoflurane combined with remifentanil target controlled infusion is more valuble in the clinical anesthesia in elderly patients with tumor.