The Effect On Adrenocortical Function Of Gerontai Elder Patients With Target Controlled Infusion For Etomidate Emulsion Together With Epidural Anesthesia

Objective:To investigate the effect of TCI domestic Etomidate emulsion during general anesthesia and epidural anesthesia on the adrenal gland function of Elderly Patients during general anesthesia and epidural anesthesia undergoing super abdominal operation.Methods:Eighty patients aged60to75years were scheduled for abdominal operation, ASA Ⅰ～Ⅱ. The length of the operation about3hours. Before the operation, the patients who had got mental or nervous disease, severe hepatic and kidney disease, adrenal gland disease or other endocrine system diseases, the history of drug were exclude from the study. The patients were randomly divided into two groups, the first group (E,): TCI domestic Etomidate emulsion for general anesthesia and epidural anesthesia; The other (E2):TCI domestic Etomidate emulsion for general anesthesia. During the operation, the patients were injected lmg Penehyclidine, and the patients’MAP, HR, ECG, SPO2and BIS with PSM were continuously monitored. Group E, were taking visible epidural puncture tube, injected3ml1%lidocaine, started the induction after oxygen up for5min. TCI etomidate0.8μg/ml, injected atracurium0.15mg/kg and sufentanil0.3～0.5μ g/kg with target controlled infusion; Continuously infused remifentanil0.1-0.2μ g/kg. min and atracurium0.6～0.8mg/kg or anaesthetic (1%lidocaine-0.1875%ropivacaine) with infusion-pump during operation; regulationed the concentration of etomidate in accordance with BIS(50-55), discontinuanced the drug lOmins before the end of operation. The induction of genera] anesthesia of group E2was same as E,, infused remifentanil0.1～0.2μg/kg. min, atracurium0.6～0.8mg/kg. h, etomidate0.5～0.7μ g/ml with infusion-pump during operation; regulationed the concentration of etomidate in accordance wi th BIS (50-55), discontinuanced the drug10mins before the end of operation. Removed the tube when the spontaneous respiration of patient was recovered. Record the time to resuscitation, the recover of autonomous respiration and the time of removing the tube. Drew venous blood before anesthesia (t0), after the operation (t1),24h after the operation (t2) and48h after the operation (t3). Measured the concentration of CORT, ACTH and ALD by RIA. Results:(1) There was no significant difference between tow groups at age, weight and operating time (P>0.05).(2) The recover time of spontaneous respiration and time of drawing tube of group E, is shorter than E2(P<0.05).(3) There was no significant difference between tow groups at the concentration of CORT, ALD and ACTH before operation. The concentration of CORT was reduced after operation in both groups,(E1, P<0.05; E2, P<0.01).24h after the operation, the concentration of CORT recovered.48h after the operation, the concentration of CORT rose in both groups (E1, P>0.05; E2, P<0.05; E, to E2, P<0.05). The concentration of ACTH rose in both groups (E1, P<0.05; E2, P<0.01; E2to E2, P<0.05).24h after the operation, the concentration of ACTH recovered. There was no significant difference between two groups at the concentration of CORT in any stage.Conclusion:TCI domestic etomidate emulsion for general anesthesia and epidural anesthesia the concentration of CORT, ALD and ACTH varied very small during interoperation and post operation, it has less suppression on the adrenal gland of old patients.24h post operation, all of three index has recovered, and the analgesic effect is best, so the TCI domestic etomidate emulsion for general anesthesia and epidural anesthesia can be safely used in the underbelly operation of old patients.