Feasibility Study Of Etomidate Applied To Elderly Patients In Total Intravenous Anesthesia

Objective To discuss the possibility of the application etomidate and remifentanil to elderly patients within two hours in total intravenous anesthesia.Methods90cases of selected patients with operation, ASA Ⅱ-Ⅲ level, were randomly divided into three groups of30each,using a random number table: etomidate group (group E, n=30), propofol (group P, n=30) and Sevoflurane group (group S, n=30). The medication that used for the induction of anesthesia are as follows:Group E were in turn injected midazolam0.04mg/kg, fentanyl4μg/kg, etomidate0.3mg/Kg, cisatracurium besilate0.15mg/kg; group P and S were also in turn injected midazolam0.04mg/kg,fentanyl4μg/kg, propofol1.5mg/Kg, cisatracurium besilate0.15mg/kg. The intravenous anesthesia maintenance medication of the three groups were maintained by target controlled infusion.The target plasma concentration of etomidate in group E is0.3-0.32ug/ml; the target plasma concentration of propofol in group E is1.5-2μg/ml. patients in group S continued to inhale sevoflurane0.2-2.5%and the end-tidal concentration was maintained at0.5-1.2MAC. Three groups of patients are composite remifentanil target-controlled infusion (target plasma concentration2-2.5ng/ml), intermittent bolus cis cisatracurium besilate0.03mg/ml to maintain muscle relaxant. The changes of hemodynamic, cortisol, adrenocorticotropic hormone (ACTH), aldosterone, adverse effect, postoperative recovery of before the induction of anesthesia (TO), immediately after the induction of anesthesia (T1), the beginning of the surgery(T2),2h after the beginning of surgery (T3) and24h after surgery (T4) were recorded.Results All groups have the same stabilized hemodynamics,while hemodynamic fluctuations in group E was significantly smaller than the other two groups(p<0.05), The concentration of cortisol,and aldosterone that2h after the beginning of surgery (T3) in group E were significantly lower than before the induction of anesthesia (TO)(p<0.05), and hormone (ACTH) were significantly higher than before the induction of anesthesia (TO)(p<0.05). but at each time plasma cortisol, adrenocorticotropic hormone (ACTH), aldosterone content were within the normal range. The concentration of plasma cortisol and adrenocorticotropic hormone (ACTH), aldosterone had no significantly change(P>0.05).Conclusions Etomidate had litter effects on the cardiovascular and was more suitable for surgery under general anesthesia in elderly patients. The effection of adrenal suppression is transient and reversible when etomidate used. Etomidate could be safely used to maintain for TIVA of those elderly patients within two hours.