The Effect Of Desflurane On Quality Of Recovery In Elderly Patients With Thoracotomy

Objectives:Desflurane was applied to anesthesia in elderly patients undergoing thoracotomy.We observed the quality of recovery and explored the safety and effectiveness of its clinical application.Method:90 elderly patients scheduled for thoracotomy under general anesthesia from June 2017 to February 2018 were enrolled in this study,with the standard of ASA II to III,60 to 80 years old and 40 to 90kg weight.The patients were randomly divided into three groups:the experimental group was the desflurane group（Group D,n=30）,the control group were the propofol group（Group P,n=30）and the sevoflurane group（Group S,n=30）.All patients were fasted preanesthesia and were used the same intravenous rapid induction of anesthesia.Patients in group D were inhaled with 6 to 8%desflurane intraoperatively,and were continuously infused with remifentanil hydrochloride 0.15 to 0.3μg/kg/min at the same time.In group P,patients were continuously infused with propofol 4 to 12mg/kg/h and remifentanil 0.15 to0.3μg/kg/min during operation.Patients in group S were inhaled with sevoflurane at a concentration of 2 to 3%intraoperatively,and were continuously infused with remifentanil hydrochloride 0.15 to 0.3μg/kg/min at the same time.All patients were given fentanyl citrate 2μg/kg at the beginning of surgery.All patients were added cis-atracurium 0.05mg/kg every 30 minutes,and the muscle relaxation was stopped while the chest cavity closed.Fentanyl citrate 2μg/kg was added additionally 5 minutes before the end of surgery.BIS values was maintained within a range of 40 to 60 in operation,and the amount of anesthetics was adjusted according to the BIS values.P_ETCO₂ was maintained between 30 to 40mmHg,and the parameters of the anesthesia machine was adjusted according to P_ETCO₂.The anesthetic drugs infusing were stoped at the end of surgery immediately.Meanwhile,the fresh air flow of the three groups was modulated 5L/min and the respiratory rate was 20 beats/min.When the patients awakened,we pulled out the tracheal tube,and then transferred them to PACU.When they were fully awake,we returned them to the ward care unit.（1）The MAP,HR and SpO₂ were recorded at these time points which was entrance time（T₀）,intubation time（T₁）,at the beginning of the surgery（T₂）,30 minutes after surgery（T₃）,at the end of surgery（T₄）,extubation time（T₅）and 10 minutes after extubation（T₆）.（2）We recorded the operation time（t₀）,the recovery time（time from the end of surgery to the patient’s eyes open or body movement,t₁）,extubation time（time from the end of operation to tracheal tube extubation,t₂）,the PACU residence time（t₃）and hospitalization time after surgery（t₄）.（3）We recorded the postoperative agitation score at these time points which were extubation time,10 minutes after extubation,20minutes after extubation and 30 minutes after extubation.（4）We recorded the MMSE score at these time points which were 1 day before surgery,1 day after surgery and 3days after surgery.（5）We recorded the VAS score at these time points which were extubation time,30 minutes after operation,1 day after operation and 3 days after operation.（6）We also recorded the incidence of postoperative adverse reactions.Results:1.There was no significant difference in gender,age,height,weight and ASA grade between the experimental group and the control group.2.There was no significant difference in MAP,HR and SpO₂ between the experimental group and the control group at each time point.3.Compared with group P,t1 and t2 were significantly shorter in group D and the difference was statistically significant（p<0.05）,and there was no significant difference in t0,t3 and t4 between two groups.Compared with group S,t1,t2 and t3were significantly shorter in group D and the difference was statistically significant（p<0.05）,and there was no significant difference in t0 and t4 between two groups.4.There was no significant difference in postoperative agitation score between group D and group P.Compared with group S,the score of agitation at extubation time was significantly lower in group D and the difference was statistically significant（p<0.05）,but there was no significant difference in agitation score at 10 minutes after extubation,20 minutes after extubation and 30 minutes after extubation.5.There was no significant difference in the MMSE score between the experimental group and the control group at 1 day before surgery,1 day after surgery and 3 days after surgery.6.There was no significant difference in the VAS score between the experimental group and the control group at extubation time,30min after operation,1day after operation and 3 days after operation.7.The number of postoperative drowsiness and respiratory depression in group D was lower than that in group P,and the number of nausea and vomiting was higher in group D than in group P,but there was no significant difference between the two groups.Drowsiness,nausea,vomiting,and respiratory depression were lower in group D than in group S,but the difference was not statistically significant.Conclusions:1.Desflurane can safely be used in anesthesia for thoracotomy in elderly patients and the patients’hemodynamic was stable.2.With the application of desflurane in elderly patients,the postoperative recovery was fast and high-quality,the extubation time and the PACU residence time was short,the incidence of adverse reactions after surgery was not increased,it was beneficial to the patients’turnover and saving medical resources.3.In elderly patients undergoing general anesthesia,there was no significant difference in the early postoperative incidence of POCD between dsflurane and propofol or sevoflurane.