The Clinical Observation Of Various Adjunctive Drugs During Epidural Anesthesia In Patients Undergoing Gynecological Surgery

Objective To observe the sedative and amnestic effects, the degree of muscle relaxation and prevention of visceral traction reaction of various adjunctive drugs in patients undergoing gynecological surgery under epidural anesthesia.Methods Sixty patients (ASA I～II ) scheduled for elective abdominal hysterectomy were randomly divided into three groups:Group I:fentanyl and midazolam;Group II:pethidine and midazolam;GroupⅢ:sulfentanil and midazolam. We selected L2～3 intervertebral space as the puncture site of epidural anesthesia and used 0.75% ropivacaine after test dose, adjusting the anesthesia level to T6-8～S4. All the adjunctive drugs were intravenously administered slowly 5 minutes before incision. The blood pressure and heart rate were recorded at the time of preanesthesia, incision, surgical exploration, uterus traction, suturing abdominal cavity and the end of operation. The degree of sedation, muscle-relaxing, visceral traction reaction and the incidence of side-effects were evaluated and observed during the operation. The patients were postoperatively surveyed to evaluate the degree of amnesia.Results The MAP of three groups decreased significantly after the adjunctive drugs were administered,compared with the preanesthesia period (P<0.05); the MAP recoveried at the end of operation in I group andⅡgroup; theⅢgroup's MAP was lower than the other two groups'at the end of operation(P<0.05). The lowest MAP in I group happened at the time of uterus traction and it was lower significantly than the other two groups'. The HR was not different inⅡgroup andⅢgroup, compared with the preanesthesia period. The I group's HR was decreased when entering abdomen cavity, and it was lowest at the time of uterus traction (P<0.05). And it was lower significantly than theⅡgroup's. As to the degree of visceral traction reaction, the I group's was stronger than the other two groups'(P<0.05). The effects of abdominal muscle relaxation ofⅡgroup andⅢgroup were better than that of I group (P<0.05). The Ramsay Sedation Scale ofⅢgroup was higher than that of I group(P<0.05).Ⅱgroup andⅢgroup had better amnesia effect than I group (P<0.05). The SpO2 in three groups were not different. The incidences of nausea were not different and there were no incidences of pruritus and vomiting in three groups.Conclusion Pethidine and sulfentanil respectively combined with midazolam can prevent the visceral traction reaction in patients undergoing gynecological surgery under epidural anesthesia. The patients have stable circulation, good muscle relaxation, satisfactory sedation and amnesia effect. They are effective and safe adjunctive drugs in patients undergoing gynecological surgery under epidural anesthesia.