Effects Of Sevoflurane And Propofol On Hemodynamics And Hs-cTnI In Breast Cancer Patients Who Undergoing Radical Mastectomy After Epirubicin Chemotherapy

Objective: To observe the effects of total sevoflurane inhalation anesthesia and propofol intravenous anesthesia on hemodynamics and hs-cTnI in breast cancer patients undergoing radical mastectomy after epirubicin chemotherapy,and to explore which anesthesia method have an advantage in cardioprotection for breast cancer patients with radical mastectomy after epirubicin chemotherapy.Methods: Sixty breast cancer patients who underwent radical mastectomy with neoadjuvant chemotherapy with epirubicin before operation in the Affiliated Tumor Hospital of Guangxi Medical University from March to December in 2018 were enrolled in the sevoflurane group(group S)and the propofol group(group P),30 cases in each group respectively.Anesthesia induction: inhalation(6-8% sevoflurane + pure oxygen 6L / min)were accepted in the patients of group S,and intravenous propofol of dose 1-1.5mg / kg were accepted in the patients of group P.In addition,all patients in both groups were intravenous sufentanil of dose 0.3-0.5ug /kg,when the patient’s consciousness disappeared intravenously cisatracurium of dose 0.2mg/kg,patients wasintubated tracheal tube mechanical ventilation when BIS values in 40-45.Anesthesia maintenance: Patients were maintained when BIS values between40-50 during surgery.Patients continued to inhale sevoflurane(1-2Mac)in group S,and patients continued intravenous injection of propofol of dose6-10mg/kg.h in group P,in addition to continuous intravenous infusion of sufentanil of dose 0.010-0.015ug/kg.h,and cisatracurium of dose 0.1mg/kg.h.Patients’ HR,MAP,CI,SVV,SVR were collected at 5 time points such as before anesthesia induction(Ta0),before tracheal intubation(Ta1),1 min after tracheal intubation(Ta2),at the time of incision(Ta3),and at the end of surgery(Ta4).The venous blood of the patients were taken to detect serum hs-cTnI,CK-MB,CK and LDH at 3 time points such as 5min before induction(Tb0),6h after induction(Tb1)and 24 h after induction(Tb2).At the same time,the amount of sufentanil in the operation and the use of vasoactive drugs were recorded.The cumulative dose of epirubicin was recorded and the patient’s intraoperative knowledge was assessed 24 hours after surgery.Results:(1)General information of patients,the operation time,anesthesia time,the dose of sufentanil,and the use of vasoactive drugs were not statistically significant.The cumulative dose of epirubicin was not statistically significant.Patients were assessed for no intraoperative knowledge 24 hours after surgery.(2)HR: Compared with Ta0,HR in Ta1 and Ta3 decreased significantly(P<0.05),and decreased in Ta1 in group S(P<0.05).The HR of the two groups was significantly higher in Ta2 than in Ta0,but the increase in group S was lower than that in group P(P<0.05).(3)MAP: Compared with Ta0,the MAP of the two groups decreased significantly in Ta1 and Ta3(P<0.05),and the MAP of the group S decreased significantly in Ta2 compared with Ta0(P<0.05),while the MAP in the group P increased significantly in Ta2 comparedwith Ta0(P<0.05).(4)SVV,SVR,CI: SVV in the two groups were decreased significantly than Ta0 in Ta1(P<0.05),SVR in the two groups were significantly lower than Ta0 in Ta1(P<0.05),and CI in group P was significantly lower than Ta0 in Ta1 and Ta2(P<0.05).There was no statistically significant difference between the two groups in SVV,SVR and CI.(5)hs-cTnI and CK-MB、CK、LDH: the two groups showed an upward trend in Tb0,Tb1,Tb2,and the S group was significantly lower than the group P(P<0.05).The CK-MB,CK and LDH in the two groups were significantly higher than the baseline value Tb0(P<0.05).There was no significant difference in CK-MB,CK and LDH between the two groups.Conclusions:(1)Compared with propofol total intravenous anesthesia,sevoflurane total inhalation anesthesia is more stable on hemodynamics in breast cancer patients undergoing preoperative chemotherapy with epirubicin neoadjuvant chemotherapy.(2)Compared with propofol total intravenous anesthesia,sevoflurane total inhalation anesthesia can reduce the release of hs-cTnI from myocardial injury markers in patients receiving neoadjuvant chemotherapy with epirubicin,indicating sevoflurane pair patients with neoadjuvant chemotherapy with rebubicin were superior to propofol in cardioprotection.