The Comparative Study Of Total Intravenous Anesthesia And Combined Intravenous-inhalational Anaesthesia For Orthopedic Surgery In Elderly Patients

Objective: To compare effects of total intravenous anesthesia and combinedintravenous-inhalational anaesthesia on intraoperative hemodynamics parameters，postoperative recovery and incidence of adverse events in elderly patient duringorthopedic surgery.Methods:26patients (10males and16females)，aged73～97years old，ASA II～III，undergone general anesthesia for fracture femoral neck，femoral intertrochantericand intertrochanteric fracture with closed reduction and intramedullary nail fixationwere enrolled in the experiment. They had height150～182cm，body weight33～75kg；19cases complicated with hypertension，5cases of coronary heart disease，5cases ofdiabetes，8cases of respiratory disease；11cases of ASA Ⅱ，15cases of ASA Ⅲ. Allsubjects were randomly assigned into two groups with different methods of anesthesiamaintenance： combined intravenous-inhalational anaesthesia group (anestheticmaintenance with propofol and sevoflurane，group S，n=13) and total intravenous group(anesthetic maintenance with propofol and remifentanil，group R，n=13).Induction of anesthesia：anesthesia was induced with midazolam0.03mg/kg，sufentanil0.4~0.6μg/kg，etomidate0.3mg/kg，cisatracurium besilate0.2mg/kg in thetwo groups. Maintenance of anesthesia：group S, constant infusion of propofol at3~4mg/kg/h and sevoflurane at0.5~4%；group R, constant infusions of propofol at4~6mg/kg/h and remifentanil at0.05~0.25μg/kg/min. Remifentanil and propofol wereinfused via micro infusion pump. For muscle relaxation, duly supplement ofcisatracurium besilate at0.1mg/kg according to operative situation. The depth ofanesthesia was adjusted by changing the concentration of inhalation drug or the pumprate of remifentanil，maintaining BIS between40~60.Monitoring indicators：SBP，DBP，HR，SV，CO，TFC，ACI，SVR. Monitoring time points：baseline value (T0)，immediately before intubation (T1)，immediately afterintubation (T2)，operation incision (T3)，intraoperative maximum blood pressure (T4)，intraoperative minimum blood pressure (T5)，immediate extubation (T6)，5mins afterextubation (T7)，10mins after extubation (T8). At the same time，the concentration ofend-tidal sevoflurane，the speed of remifentanil，the usage of vasoactive drugs andpostoperative spontaneous breathing recovery time，extubation and response time wererecorded. Assessment of awakening quality and the degree of pain at1min afterextubation and20min after extubation，and observation of the postoperative incidenceof adverse events.Results: Values of HR，DBP，SV，CO，ACI，TFC，SVR in each time point werenot significant difference of (P>0.05) between the two groups. While SBP value at T5time point was statistically significant difference (P<0.05) between the two groups，andgroup S was higher than group R. In group S，CO value in T2，T4to T8point in timewas lower than it in T0；While in group R，CO in T2to T5point in time was lower thanT0，and those differences were statistically significant (P<0.05). SVR value in T1weresignificantly lower than the respective in T0in both groups，and the differences werestatistically significant (P<0.05). The number of cases using vasoactive drugsintraoperatively were not statistically significant between the two groups (P>0.05).Spontaneous breathing recovery time，extubation and response time in group Swere significantly longer than them in group R，and the differences were statisticallysignificant (P<0.01). Those differences of the two groups of the awakening quality werenot statistically significant (P>0.05)； pain score for1min after extubation was nostatistical significance between the two groups (P>0.05)，however the score at20minafter extubation was statistic significance (P<0.05)， it was lower in group S than ingroup R. All patients had not reported dysphoria，were not aware of operative process.Only one case reported feeling of nausea in the group S.Conclusions: Both anesthesic methods can maintain stable hemodynamics duringorthopedics operation in elderly patients. The recovery time of the combinedintravenous-inhalational anaesthesia is longer than it of total intravenous anesthesia，however both methods do not cause delayed recovery. Occurrence of postoperative painwith total intravenous anesthesia is earlier than one of intravenous inhalation anesthesia.Both anesthestic methods can be used safely and effectively in elderly patientsundergoing orthopedics operation.