Effect Of Etomidate Intravenous Anesthesia Combined FICB On POCD In Elderly Patients Undergoing Total Hip Replacement

Objective: To discuss the effect of etomidate intravenous anesthesia combined fascia iliaca compartment block on postoperative cognitive dysfunction in elde--rly patients undergoing total hip replacement.Methods:Ninety-six elderly patients who are scheduled for unilateral total hip replacement were enrolled and randomly divided into three groups: etomidate intravenous anesthesia combined FICB group(group NE,n=32),sevoflurane anesthesia combined FICB group(group NS,n=32),etomidate intravenous anesthesia group(group E,n=32).The vital signs were monitored after patients into the operating room,and inspiring oxygen with mask after premedicated with midazolam 0.03mg/kg.Line on the left side of the radial artery puncture catheter under local anesthesia to monitor blood pressure,and NE group and NS group need to apply FICB.Patients with nerve blook of success and E group were induced with intravenous sufentanil 0.3ug/kg,etomidate 0.2-0.3mg/kg,cisatracurium 0.15mg/kg followed by mask insertion and ventilation.All the patients were given a in--fusion of remifentanil at 0.08-0.3ug/kg/min.The patients in group NE and group E were given a continuous intravenous infusion of etomidate at 7-14ug/-kg/min,while the patients in group NS were given a sevoflurane anesthesia at2-4%,and regulated the dose of etomidate or sevoflurane according to the BIS to maintain the BIS value between 40 to 60.The patients in three groups were give a PCIA,and maintained the VAS score less than or equal to 3.MAP,HRwere record at preoperative(T0),before cutting leather(T1),when placing prosthesis(T2),after the operation(T3).Infusion volume of saline/colloid,blood loss,urine volume,preoperative and postoperative hemoglobin,anesthesia time,operation length,vascular active drug usage,remifentanil dosage,the incidence of complications and the number of additional analgesics were recorded.The intravenous blood samples were collected at day 1 before operation,day 1 and day 3 after operation respectively to detect the concentration of s100 ? and NSE,and the MMSE was applied to evaluate POCD.Result:1.No significant differences among three groups in male/female ratio,age,weight and education level(P>0.05).2.Infusion volume of saline/colloid,blood loss,urine volume,anesthesia time,operation length in three groups of patients were not satistical significance(P>0.05);Preoperative hemoglobin in three groups of patients was not stastistical significance(P>0.05);The postoperative hemoglobin in all groups compared with preoperative hemoglobin decreased significantly(P<0.05),but no significant differences found among three groups(P>0.05).3.There were no differences in HR? MAP among all groups at T0?T3(P>0.05);No differences were found in HR?MAP at each time point in NE group(P>0.05);In NS group,HR?MAP had differences at each time point(P<0.05);Compared with T0?T3 point,HR?MAP decreased significantly at T1?T2 point,however there was no significant differences between T1 point and T2 point,or between T0 point and T3 point(P>0.05);At T1?T2 point,HR?MAP in NS group were significantly lower than those in NE group(P<0.05),but there were no significant differences betweenNE group and E group(P>0.05);HR?MAP in E group compared various time points no difference(P>0.05),and E group and NE group was no difference(P>0.05);Three groups of patients who used the number of nitroglycerin was no significant difference(P > 0.05);The number of patients who used dopamine in NS group was more than in NE group,with significant differences(P<0.05),but no difference was found between E group and NE group or NS group(P >0.05).4.The MMSE score at day 1 before surgery was no significant differences among three groups(P > 0.05);There were no differences of the MMSE score in NE group(P > 0.05);Compared with NE group,the MMSE score in NS group and E group decreased significantly at day 1 and day 3 after surgery(P <0.05);The MMSE score in NS group and E group at day 1 and day3 after surgery was lower than those at baseline(P <0.05),while,there was no significant difference between the two groups(P >0.05).5.The serum concentration of S100?and NSE at day 1 before surgery was no significant difference among three groups(P >0.05);The levels of serum S100?and NSE in all groups at day 1 and day 3 after surgery compared with their value at day 1before surgery increased significantly(P <0.05),and were significantly higher in NS group and E group than that in group NE(P <0.05),while there was no significant difference between group NS and group NE(P >0.05).6.Three groups of patients with a total of 19 cases of POCD happened at day 1 after surgery,among them the occurring rate of group NE(2 cases,6.9%)was lower than group NS(8 cases,29.6%)or group E(9 cases,28.1%),with statistical significance(P <0.05);There were 15 patients suffered from POCD at day 3after surgery,among them group NE(1 patient,3.4%)was lower than group NS(6 patients,22%)or group E(8 patients,25%),and the incidence of POCD had significant difference(P <0.05);The incidence of POCD had no difference between group NS and group E at day 1 and day 3 after surgery(P >0.05).7.There were no intraoperative awareness,puncture associated infection or puncture associated nerve injury in all patients after operation.The incidence of postoperative nausea and vomiting in group NE ? NS ? E was 20.7%(6patients)?14.8%(4 patients)?28.1%(9 patients)respectively,no statistical significance(P >0.05).8.Intraoperative dosage of remifentanil in three groups of patients(E group>NE group>NS group)had significant difference(P <0.05);The number of additional analgesics in E group was more than in group NE or group NS,but no differences were found between NE group and NS group(P >0.05).Conclusion: Etomidate intravenous anesthesia combined FICB on POCD in elderly patients undergoing total hip replacement,which have certain protective effect on the central nervous system,could reduce the incidence of early POCD,and reduce the serum concentration of S100?and NSE at day 1and day 3 after operation.