The Application Of Anesthesia Management Based On The Concept Of Fast Track Surgery On Patients Undergoing Colorectal Surgery

Objective:In order to guide the optimize selection of clinical pathway, we designed a randomized controlled trials to help formulate appropriate anesthesia procedure, by observing the effect of stress reaction in patients on the operation process of colorectal surgery anesthesia based on the concept of Fast Track Surgery.Methods:We choice 124 cases of laparoscopic radical resection of colorectal cancer under general anesthesia by random selection, ASA I to II, age≤75 years old. They were divided into 3 groups as traditional control group(A group) 、surgical application group of FTS( B group) and epidural anesthesia group of FTS(C group) by the different treatments in perioperative period, 41 patients in A group, 42 patients in B group and41 patients in C group. B group and C group were carried out according to the FTS concept, such as shorten the fasting time, non mechanical enema, intraoperative heat preservation, limited infusion, postoperative multimodal analgesia, removing drainage tube early, early feeding and activiting etc, and epidural anesthesia and analgesia were used in the Cgroup. A group was carried out according to the traditional routine process. We compared preoperative levels of tension above the three groups, and detected stress factors respectively as the time when patients went into the operation room after arterial puncture( sign as T0), 1 hour after surgery began( T1), immediately after the operation( T2), 4hours after surgery( T3), 1 day after surgery( T4) and 5days after surgery( T5), including C reactive protein( CRP), tumor necrosis factor( TNF), interleukin-6( IL-6), adrenocorticotropic hormone( ACTH) and cortisol etc. At the same time We detected blood glucose in three groups of patients on the time of in the operation room(T0),surgery began immediately(T1), surgery began 1 hours(T2),immediately after the end of surgery(T3), 2 hours after surgery(T4).We recorded index of three groups of patients with postoperative urine volume, pain, pressing the analgesia pump times, the exhaust time, the defecation time, recovery time of a normal diet, hospital stay, hospital costs etc, and conducted statistical analysis.Results:There was no significant difference in age, sex, basic condition,operation mode, operation time and SAS anxiety score in the three groups(P>0.05), The value of ACTH in the three groups increased at each point of time after operation, and gradually decreased to normal level at 1 days after operation, The ACTH values of the two groupsrelated FTS were lower than those of the A group at each time point(P<0.05), and 1 hour after the operation the level of ACTH in group C was less than that in group B(P<0.05). The levels of TNF and cortisol in the three groups were increased at a time point after operation, and gradually decreased to normal level at 5 days after operation, and the value of the two groups related FTS at each time was lower than the A group(P<0.05), and 1 day after the operation, the level of ACTH in group C was less than that in group B(P<0.05). The levels of IL-6 and CRP were significantly different above the three groups in the 5 days after the operation(P<0.05), and the values of FTS ralated groups were significantly lower than those of the A group(P<0.05), the blood glucose fluctuation was more obvious in the A group. During the course of hospitalization, the time of FTS related groups was significantly less than that of the A group for the time of defecation, the time of defecation and the length of hospital stay, at the same time, the recovery time of gastrointestinal function in C group was less than B group(P<0.05).Conclusion:For patients undergoing elective colorectal surgery under general anesthsia, our anesthesiologist should collaborate with all departments,apply the peri-operative work process based on the enhanced recovery theory to effectively control the pathological and physiological responses of the patients during perioperative period, reduce surgicalstress response, reduce the patient’s postoperative pain, reduce the length of hospital stay, promote the rapid recovery of patients, increase patient satisfaction.