Esia Combined With Intravenous-inhalational Anesthesia On Patients Undergoing Extensive Hysterectomy In Stress: A Comparison With Intravenous-inhalational Anesthesia

OBJECTIVE: To compare the effect of epidural anesthesia combined with intravenous-inhalational anesthesia on patients undergoing extensive hysterectomy with intravenous-inhalational anesthesia.,and explore an appropriate anesthesia methods in clinical practice,to regulate and control the adverse effect of perioperative stress,expect to provide a theoretical basis for the selection of appropriate anesthesia.METHODS: Sixty ASA I-II patients scheduled for extensive hysterectomy,aged 18-75 yr,weighing 45-80 kg,were randomly divided into two groups according to the random number table(n=30): Intravenous-inhalational anesthesia group(group GA)and epidural anesthesia combined with intravenous-inhalational anesthesia group(group GE).The patients were forbidden diet preoperative routinely and weren't given medication before anesthesia.Monitor their vital signs and establish their venous access after they entering into the operating room,Group GA were treated with endotracheal intubation under general anesthesia,and intraoperative anesthesia were maintained by combined intravenous-inhalational anesthesia;In group GE,they were performed epidural puncture catheterization,then treated with endotracheal intubation under general anesthesia after the onset of 2% lidocaine,the intraoperative anesthesia were maintained by epidural anesthesia combined with intravenousinhalational anesthesia.After the insertion of the catheter,they were performed theright internal jugular vein puncture and radial artery puncture,monitoring central venous pressure and invasive arterial pressure.The patients were maintained the stability of the circulatory system,and the end tidal partial pressure of carbon dioxide(PETCO2)were maintained at 35~45mm Hg.The changes of blood pressure and heart rate were recorded and compared between the two groups at the time of entering the operation room,induction of anesthesia,at the beginning of surgery,10 min after operation,30 min after operation,60 min after operation,and at the end of surgery.They were taken blood samples from radial artery respectively before the operation(T1)and 1 hour after the operation begin(T2)and during skin suture when the operation is over(T3).And all patients were performed with intravenous patient-controlled analgesia(PCIA)after surgery,then entered the resuscitation room.Two groups were determined arterial blood gas analysis at different time points and recorded the blood glucose concentration and blood lactic acid levels at different time points;Follow up the patients' postoperative analgesia and they were recorded at 0,2,4,8,12,24,48 h VAS analgesia score after operation;The blood glucose concentration,blood lactic acid levels and VAS score at each time point were compared between the two groups.RESULTS: There were no statistical significance between the two groups in terms of age,weight,time of operation and volume of fluid((49)> 0.05).There were no statistical significance in blood pressure and heart rate between the two groups at each time points((49)> 0.05).The perioperative blood glucose and blood lactate concentrations of two groups fluctuated in the normal physiological range.Compared with T1,the blood glucose concentration in group GA were higher at T2 and T3,the concentration of lactic acid were higher at T2 and T3,while the blood glucose concentration in group GE were higher at T2 and T3,the concentration of lactic acid were elevated at T3((49)< 0.05).Compared with the group GA,the blood glucose concentration of group GE descended during T2 and T3,and the concentration of lactic acid descended during T3((49)< 0.05).Compared with the group GA,the VAS score in group GE were decreased at the time point of 0,2,4,8,12,24h(P < 0.05),and there were no significant difference in VAS scores between the two groups during 48h((49)> 0.05).CONCLUSION: Compared with simple intravenous-inhalational anesthesia,patients undergoing extensive hysterectomy take epidural anesthesia combined with intravenous-inhalational anesthesia have more superiority.Epidural anesthesia combined with intravenous-inhalational anesthesia can produce preemptive analgesia,reduce blood glucose and blood lactic acid levels,reduce the postoperative VAS score,and therefore reduce the level of stress.