The Influence Of Isoflurane Inhaled General Anesthesia In Combination With Epidural Anesthesia Of Lidocaine By Two Way On Hemodynamics Of Patients For Gastric Carcinoma Surgery

Objective: This trial was designed to evaluate theinfluence of isoflurane inhaled general anesthesia incombination with epidural anesthesia of lidocaine by two wayon hemodynamics of patients for gastric carcinoma surgery,toprovide evidence for the clinical application of inhaled generalanesthesia in combined with epidural anesthesia.Methods: Thirty patients, male 17 and female 13,aged42⁵8yr, weight 46⁸5kg, ASA grade â… ^â…¡, scheduled forelective gastric carcinoma surgery were included in the study.Patients were excluded if they had cardiac, pulmonary, hepatic,renal, psychoneurotic diseases. Patients were randomly dividedinto two groups of fifteen each: group â… received isofluraneinhaled general anesthesia +intermittent epidural lidocaineinjection, group â…¡received isoflurane inhaled generalanesthesia+continuous epidural lidocaine infusion viamicro-pump. All patients were premedicated with diazepam0.2mg/kg, atropine 0.01mg/kg intramuscularly 30min beforeanesthesia. An intravenous cannula was placed for fluidadministration. Lactatde Ringer`s solution was infused at20ml/kg/h. After sterilization, an epidural puncture wascarefully performed with a 18-gauge at the T<sub>8<sup>9</sup></sub> intervertebralspace using a median approach in the righe lateral flexedposition. A catheter was inserted into epidural space in acephalad direction for 3cm. The patient was the placed supine. Atest dose of 4ml of 1.5% lidocaine was given to excludeintrathecal position. The initial dose about 0.1ml/kg lidocaine1.5% was injected in 30s. In group â… , injected 0.1ml/kglidocaine 1.5% in 30s epidurally at 1h intervals; while in groupâ…¡,followed lidocaine 1.5% infusion continuously viamicro-pump at 0.1ml/kg/h till the end of the operation. Fifteenminutes after the intial infusion, the analgesic levels wereevaluated by the pinprick method. General anesthesia wasinduced with fentanyl 2<sup>3</sup>μg/kg and propofol 1.5<sup>2</sup>mgkg IV.Endotrached intubation was facilitated by IV atracuronium0.5<sup>0</sup>.6mg/kg. Ventilation was controlled mechanically(VT=10ml/kg, , RR=12/min, I:E=1:2) to maintain the partialpressure of expiratory carbon dioxide between 35 and 45 mmHg.General anesthesia was maintained with an end-tidalconcentration of 0.5-0.8vol% isoflurane in oxygen to keep BISindex at about 60±5. IV atracuronium 0.2<sup>0</sup>.4mg/kg wasadministrated intermittently. After tracheal intubation, Ringer`ssolution was infusion at 10ml/kg/h and blood loss was replacedby an equal volume of 6% HES solution when the loss were lessthan 1000ml. If more than 1000ml ,the blood were needed. SBP,DBP, HR, SpO₂ , ECG and CVP were monitered during theprocedures. CO, CI were measured by NICO₂ TM noninvacivedcardiac output monitor and SVR was calculated by80(MAP-CVP)/CO. The values of arterial blood gas analyseswere provided to correct the results of NICO`s measments afterfifteen minutes. MAP, HR, CVP, CO, CI, SVR was recorded at60min, 75min, 90min, 120min, 135min, 150min ,180min afterthe epidural initial dose. Meanwhile BIS index , the end-tidalconcentration of isoflurane, FiO₂ and ETCO₂ was monitered.While time of operation , volume of blood loss, urine, fluidadministration and lidocaine, upper analgesic levels and thenumber of blocked nerves were recorde correctly.Results: In group â… , the level of MAP and CVP at75min and 135min decreased from the level at 60min afterepidural intial dose infusion(p<0.05);The level of SVR at75min,90min,135min,150min decreased from the level at60min after epidural intial dose infusion(p<0.05). In group â…¡the level of MAP and CVP at 75min,135min and level of SVRat 75min,90min,135min,150min after epidural initial doseinfusion were higher than the level of the same time in group â… (p<0.05);In group â…¡, all these values remained stable andhad no statistically significant(p>0.05).Conclusion: If the cardiac sympathetic nerve(T_1⁵) werenot completely blocked by the epidural anesthesia, theflunctuation of hemodynamics during the period of maintainingisoflurane inhaled general anesthesia combind with continuousmicro-pump infusion were less than combined with intermittent...