Effect Of GEA And GA On The Serum Levels Of γ-aminobutyric Acid And Postoperative Agitation

Esophageal carcinoma (or carcinoma of the esophagus) is one of the most common gastrointestinal neoplasms in clinical practice with characteristics of high incidence and poor prognosis. Despite significant progress in surgical techniques and other conventional therapeutic modalities, such as chemotherapy and radiotherapy, most patients diagnosed with esophageal carcinoma succumb to the disease in a short period. Surgical treatment at present is still considered as the preferred treatment. Carried out in recent years, concurrent chemo-radiotherapy and target gene therapy have been advanced greatly, helping many patients improve their treatment effect. But still, most of patients diagnosed with esophageal carcinoma faces great challenge and five-year survival rate of the patients with esophageal carcinoma only meets 15%-39%.In terms of resection of esophageal cancer, the method of anesthesia usually adopts general anesthesia. However, the operation of esophagectomy often takes for a long time, people have to increase the application dose of anesthetic drugs. In addition, due to the intrathoracic operation, the instability of hemodynamics in patients might do a great harm to the patients. As result, the patients are prone to suffer from sorts of complications, such as respiratory infections, hypertension, arrhythmia, agitation and other central nervous system abnormalities, seriously jeopardizing the prognosis of patients.The postoperative agitation is one of the acute complications after general anesthesia, can not only cause surgical wound dehiscence, but may also lead to the hemorrage on surgical sites as well as the circulation instability. Such complication seriously restricts the quality of recovery and even endangers the safety of patient lives. Whereas postoperative agitation mechanism is still unclear, thus there has been no special treatment available for the complication prevention and treatment methods yet. Therefore, in-depth study the postoperative agitation mechanism is warrant to addressing the complication and considered as an important issue of Anesthesiology, at present, for the reason that it can guide clinical practice to determine which factors can help prevent postoperative agitation and contribute to its effective intervention and treatment. In the previous clinical study, we found that the patients after resection of esophageal cancer prone to suffer from postoperative anesthesia agitation. This may results from the high average age of patients with esophageal cancer, poor general condition and the association with chronic alcoholism history and other factors makes the body resistant to anesthetic drugs. At the same time, we also observed that general anesthesia combined with epidural anesthesia can effectively reduce the incidence of agitation when compared with general anesthesia.As a major inhibitory neurotransmitter, GABA is the most common anesthetic substrate. Its serum level has been considered to be correlated with the occurrence of postoperative agitation. In this study, we would determine the influence of anesthetic drugs on the serum level of GABA in general anesthesia and general anesthesia combined with epidural anesthesia, in order to find out whether the difference of GABA serum level is related to the incidence of postoperative agitation.In sum, the purpose of this study is to compare general anesthesia combined with epidural anesthesia and general anesthesia on postoperative serum GABA levels in patients with esophageal cancer in order to explore the underlying mechanisms of postoperative agitation. Objective:To compare the effect of GEA(General combined Epidural Anesthesia) and GA (general anesthesia) on serum levels of γ-aminobutyric acid (GABA) and to investigate the underlying mechanism of emergence agitation in esophagus carcinoma patients during the recovering stage of anesthesia.Methods:Thirty ASA (American Society of Anesthesiology) Ⅰ～Ⅲ patients undergoing upper abdominal surgery were selected and randomly divided into GEA group and GA group. Peripheral venous blood was drawn before induction and at postoperative 20min, lhour time points. The serum levels of GABA were measured via enzyme linked immunosorbent assay(ELISA).Results:It shows no significant difference between the two different groups on the serum levels of GABA before anesthesia induction. The serum GABA level at certain time points, however, was increased significantly when comparing with that before induction (P<0.05). In addition, the serum level of GABA of the GEA group was down-regulated greatyly when compared to that of GA group.Conclusion:The results suggest that clinical application of GEA method could lower the serum level of GABA greatly, which is in accordance with the phenomenon that GEA method could decline the incidence of post-operative agitation among the patients diagnosed with esophageal carcinoma. Thus, it can be presumed that the emergence of agitation might be attributed to the high level of GABA serum level.