Comparison Of Effects With Different Anesthesia Methods On Patients' Stress-Immune Reaction In Radical Colectomy And Rectectomy

Object:: To observe certain stress and immune items of patients who underwent radical colectomy and rectectomy with different anesthesia methods and to investigate an ideal anesthesia that has fewer side effects on their stress-immune system.Methods: Forty ASA I-II patients, who were supposed to go through selective radical colectomy and rectectomy, were divided into two groups randomly: Group A (inhalational combined intravenous general anesthesia, n=20); Group B (combined inhalational- intravenous general anesthesia with combined spinal-epidural anesthesia, CSEA, n=20). In Group A, patients were induced with midazolam (0.05mg/kg) + sufentanil (4μg/kg) propofol (2mg/kg) + vecuronium (0.1mg/kg). In Group B, CSEA was performed first with 1.8ml-2.2ml 0.5% bupivacaine injected into subarachnoid space and the block level ajusted and retained for 15 minutes until it reached as high as T8. Then the same intravenous induction followed. In both groups, sufentanil and vecuronium were administrated intermittently if necessary and isoflurane was inhaled for maintenance. In Group B, 4-8ml 0.75% bupivacaine was administrated into epidural space intermittently 2 hours after the surgery began for keeping the effect of epidural anesthesia. CSI was monitored in both groups and maintained between 40 and 60 to guarantee anesthesia intensity adjust the dosage of anesthetics. NIBP, HR, ECG, SPO2, and CSI were regularly observed, and SBP, DBP, HR, and CSI were recorded at before anesthesia(T0), 1minute after intubation(T1), the strongest stimulation occurred(T2), end of the surgery(T3), leaving the operation room(T4) separately. Recovery time, extubation time and anesthesia time were recorded, too. Five milliliters of venous blood was drawn through elbow vein at T0, T2, T5(24hours after the surgery) and T6(72hours after the surgery), 4ml of which was tested for C-reactive protein, immunoglobulin(IgA, IgM and IgG) and complement(C3) with immune auto-analysis device(IMMAGE800, US). Plasma was abstracted from the rest 1ml which was placed for 20minutes and centrifuged in centrifugal tubes, and preserved in refrigerator of -80℃, then density of IL-6 was tested with radioimmunoassay and the 125I IL-6 radioimmunoassay kit was provided by Puerweiye Biotech Corporation, Limited. All the data are shown in the form of±s and analyzed by SPSS12.0 soft ware. Variance analysis was performed between groups and t test was performed in the groups. There is statistical significance when P is less than 0.05.Results: SBP in Group B declined in T1, T2, T3, T4 compared with it in Group A, and the decline was obvious in T1 and T2. In both groups, HR increased in T1, T2 and T3 and it was obviously higher in T2 in Group A. There was less variation in density of cytokines and immunoglobulin and quicker recovery in Group B compared with Group A. The recovery and extubation time was shorter than that in Group A , and less quantity of anesthetics was required with statistic significance (P<0.05).Conclusion: The application of combined inhalational- intravenous general anesthesia with combined spinal-epidural anesthesia in radical colectomy and retectomy can help to maintain stable life signs and reduce the stress reaction and immune suppression. It leads to safer perioperation period, quicker recovery, less financial burden and shorter hospitalization. It is the best choice for anesthesia in radical colectomy and rectectomy.