Effect Of Continuous Etomidate Administration On Oxidative Stress And Quality Of Postoperative Recovery In Elderly Lumbar Spine Surgery Patients

Objective:To study the effects of continuous infusion of etomidate on oxidative stress and quality of postoperative recovery in elderly patients undergoing posterior lumbar interbody fusion(PILF).Methods:A total of 80 elderly patients who underwent posterior lumbar interbody fusion under general anesthesia in the Second Hospital of Shanxi Medical University from July 2021 to July 2022 were randomly divided into an observation group(n=40)and a control group(n=40).In the observation group,etomidate,midazolam,sufentanil and cisatracurium benzoate were used for induction of anaesthesia and etomidate and remifentanil for maintenance of anaesthesia.In the control group,anaesthesia was induced using isoproterenol,midazolam,sufentanil and cisatracurium besylate,and anaesthesia was maintained with isoproterenol and remifentanil.Oxidative stress,blood rheology,adverse events and Qo R-15 scale scores were compared between the two groups before induction of anaesthesia(T0),immediately after intubation(T1),at the time of skin incision(T2),at the time of enlargement of the intervertebral foramen(T3),at the end of surgery(T4),24 hours after surgery(T5)and 72 hours after surgery(T6).The relationship between perioperative oxidative stress levels and quality of recovery was analysed between the two groups.Results:Compared to baseline values,cortisol levels were lower and adrenocorticotropic hormone levels were higher in the etomidate group at T4(P < 0.05),while both were close to baseline levels at T5 and returned to preoperative baseline values at T6.Compared to the propofol group,cortisol levels were lower in the etomidate group at T4,T5 and T6,while adrenocorticotropic hormone levels were higher at all time points compared to the propofol group(P < 0.05).Compared to T0,superoxide dismutase values increased over time and malondialdehyde values decreased in both groups(P <0.05),and superoxide dismutase values were higher in the etomidate group than in the propofol group at T5(P < 0.05),with no statistically significant differences between the two groups at the remaining time points(P > 0.05).heart rate decreased in both the etomidate and propofol groups at T1,T2 and T3 compared to T0,but The heart rate in the etomidate group was higher than that in the propofol group at the same time point,and the difference was statistically significant(P < 0.05).Compared with T0,the mean arterial pressure decreased in both groups at T1,T2 and T3,and was higher in the etomidate group than in the propofol group at all time points,with a statistically significant difference(P < 0.05).The awakening time and extubation time were prolonged in the etomidate group compared to the propofol group,but no statistically significant differences were seen(P > 0.05),nor were the differences in the length of stay in the recovery room for anaesthesia and postoperative adverse effects between the two groups(P > 0.05).However,the QOR-15 score at T5 was greater in the etomidate group than in the propofol group,and the difference was statistically significant(P <0.05).Conclusion:Continuous infusion of etomidate can effectively reduce oxidative stress,shorten hospitalization time and improve the quality of postoperative recovery in elderly patients undergoing posterior lumbar fusion,and can be safely used for intraoperative maintenance in elderly patients.