Effect Of Anesthesia Management On Postoperative Recovery In Elderly Patients Undergoing Gastrointestinal Surgery

Part one:The effect of ephedrine and norepinephrine on the prognosis in elderly patients undergoing gastrointestinal operationAbstractObjective:To investigate the effect of ephedrine and norepinephrine on the prognosis in elderly patients undergoing gastrointestinal operation.Methods:One hundred patients, aged between 60～80 years, ASA I-II, who were scheduled for gastrointestinal operation with general anesthesia were recruited in this study. The patients were randomly divided into two groups (n=50):ephedrine group (group E) and norepinephrine group (group N). Each patients was interviewed at the day before operation. The same interviewer evaluated the patients with CAM Chinese reversion (CAM-CR) during the first three postoperative days. Other information including age, sex, body mass index, complications, education time, ASA physical status, duration of operation, intraoperative fluid intake and output, duration of intraoperative hypotension, hepatic and renal function at preoperation and postoperative 1 day, VAS score at postoperative 1,3 days, and also postoperative complications were recorded. Then statistical analysis was conducted by using SPSS software version 21.0.Results:There were no significant differences in duration of operations between the two groups (10±9min VS.13±13min, P>0.05). And There were no significant differences in BUN, Cr, AST, ALT, TBil, DBil and CRP between the two groups (P>0.05). Besides, the postoperative recovery of gastrointestinal function, postoperative hospitalization stay and postoperative complications showed no significant differences between the two groups (P>0.05). Logistic regression analysis showed that long duration of operation maybe a risk factor resulting in postoperatively increased CRP level(P=0.01, OR=1.012,95% CI [1.003,1.021]), and smoking maybe a risk factor of postoperative pain(P=0.036, OR= 5.903,95% CI[1.125,30.975]).Conclusion:Under our experimental condition:1.Compared with ephedrine, a small dose infusion of norepinephrine for treating hypotension had no adverse effects on the prognosis in elderly patients undergoing gastrointestinal operation.2. Long duration of operation maybe a risk factor resulting in postoperatively increased CRP level, and smoking maybe a risk factor of postoperative pain.Part two:The incidence and risk factors of postoperative delirium in elderly patients undergoing gastrointestinal operationAbstractObjective:To investigate the incidence of postoperative delirium in elderly patients undergoing gastrointestinal operation, and aim to determine the risk factors for postoperative delirium.Methods:One hundred patients, aged between 60-80 years, ASA Ⅰ～Ⅱ, who were scheduled for gastrointestinal operation with general anesthesia were recruited in this study from May 2014 to February 2015. Each patients was interviewed at the day before operation. The same interviewer evaluated the patients with CAM Chinese reversion (CAM-CR) during the first three postoperative days. Other information including age, sex, body mass index, complications, education time, ASA physical status, duration of operations, VAS score at 1,3 days after surgery, intraoperative fluid intake and output, duration of intraoperative hypotension and other intraoperative indexes and also postoperative complications were recorded. The patients were divided into two groups according to the occurrence of delirium within 3 days after operation:postoperative delirium group (group PD) and no postoperative delirium group (group NPD). Then statistical analysis was conducted by using SPSS software version 21.0.Results:Postoperative delirium developed in 11 patients during the first three postoperative days. The incidence of postoperative delirium was 11%. The average age in group PD was (72±4), while group NPD was (66±5). The proportion of ASA 11 in group PD was (10/11), which was much higher compared with (48/89) in group NPD. The duration of intraoperative hypotension in group PD was (21±20), while group NPD was (10±9). Compared with group PD, the VAS score at 1,3 days after surgery significantly decreased (5.7±0.8 VS.4.5±0.8, 3.5±0.7 VS.2.1±0.8, P< 0.05) in group NPD. Furthermore, the proportion of patients whose VAS scores were not less than 4 in group PD was (4/11), which was much higher compared with (4/89) in group NPD, and exhibited statistically significant differences between the two groups (P<0.05). The logistic stepwise regression analysis indicated that the risk factors for delirium included advanced age, long duration of intraoperative hypotension, postoperative significant pain. Postoperatively, the first time of exhaust and ambulation, and the incidences of the postoperative cardiovascular complications did not differ significantly between two groups (P>0.05). Compared with group NPD, the first time of eating, postoperative hospitalization stay, and the incidences of the postoperative pulmonary complications, gastrointestinal complications and wound infection significantly increased in group PD (P<0.05).Conclusion:Under our experimental condition:1. The incidence of postoperative delirium was 11% in elderly patients undergoing gastrointestinal operation.2. Advanced age, long duration of intraoperative hypotension, postoperative significant pain are independent risk factors for postoperative delirium in elderly patients.3. Compared with group NPD, postoperative recovery in group PD was worse, it deserved further research.