Awakening from anesthesia using propofol or sevoflurane with epidural block in radical surgery for senile gastric cancer

摘要

Objective: To study the awakening of the elderly patients from propofol intravenous general anesthesia or sevoflurane inhalation general anesthesia combined with epidural block after radical gastric cancer surgery. Method: Eighty cases receiving selective radical surgery for gastric cancer were included. They were aged 65-78 years and classified as ASA grade I-II. Using a random number table, the cases were divided into 4 groups (n = 20): propofol intravenous general anesthesia (P group), sevoflurane inhalation general anesthesia (S group), propofol intravenous general anesthesia combined with epidural block (PE group), and sevoflurane inhalation general anesthesia combined with epidural block (SE group). For P and PE group, target controlled infusion of propofol was performed; for S and SE group, sevoflurane was inhaled to induce and maintain general anesthesia; for PE and SE group, before general anesthesia induction, epidural puncture and catheterization at T7-8 was performed. After surgery, perform patient controlled intravenous analgesia (PCIA) or patient controlled epidural analgesia (PCEA), and maintain VAS ≤ 3. The recorded indicators were as follows: time to recovery of spontaneous respiration, time to awakening, time of endotracheal tube removal, time to orientation, time to achieve modified Aldrete scores ≥ 9, modified OAA/S and Aldrete scores upon endotracheal tube removal (T1), 5 min after removal (T2), 15 min after removal (T3) and 30 min after removal (T4), dose of intraoperative remifentanil, intraoperative hypotension, and emergence agitation. Results: Time to awakening, time of endotracheal tube removal, time to orientation, and time to achieve modified Aldrete scores ≥ 9 in PE and SE group were obviously shortened compared with P and S group (P < 0.05); modified OAA/S and Aldrete scores at T1 and T2 in PE and SE group were significantly higher than those in P and S group (P < 0.05), and the scores of SE group at T1 were much higher compared to PE group (P < 0.05). Dose of intraoperative remifentanil in PE and SE group was significantly lower than that in P and S group. Conclusion: Compared to propofol intravenous general anesthesia or sevoflurane inhalation general anesthesia, propofol or sevoflurane general anesthesia combined with epidural block was more conducive to increasing the awakening quality of the senile patients from anesthesia after radical gastric cancer surgery. Moreover, sevofluorane inhalation general anesthesia combined with epidural block achieved a more stable hemodynamics and a shortened time to awakening.