The Effects Of Sevoflurane And Propofol Combined Anesthesia On Stress Response In Elderly Patients Undergoing Abdominal Surgery

Objective: To investigate the effects of sevoflurane-propofol and propofol on elderly patients undergoing abdominal surgery on stress response when Bispectral Index(BIS)was maintained at 40~60 and to provide a more suitable anesthesia method.Methods: From January 2016 to December 2016,50 patients in our hospital undergoing abdominal region surgery,male or female,aged 60-80 years,weighting ranged from 40 to 80 kg,ASA Ⅱ~Ⅲ,were randomly divided into two groups(group P:nesthesia with propofol;group C:anesthesia with sevoflurane combined with propofol),25 cases in each group.After entering the operation room,for upper extremity venous catheterization,the patients was infused Sodium Acetate Ringer’s Injection,monitoring the electrocardiogram(ECG),saturation of pulse oxidation(SpO2)and BIS.The mean arterial pressure(MAP)was monitored by left radial artery puncture catheter,and the central venous pressure(CVP)was monitored by right internal jugular vein catheterization.Induction of general anesthesia with midazolam 0.02-0.05mg/kg and sufentanil 0.3-0.4ug/kg,etomidate 0.2-0.3mg /kg.When BIS reduced to 70 below,atracurium 0.15mg/kg was injected intravenously.When BIS reduced to 55 below,tracheal intubation was performed.Then mechanical ventilation was performed in connection with the anesthesia machine.Maintenance of anesthesia: propofol was target controlled infusion as its target plasma concentration from 1.5 to 3 ug/ml in group P,Sevoflurane was inhaled MAC 0.5 as well as propofol was target controlled infusion in group C,the two groups were continuous intravenous infusion of remifentanil from 0.05 to 0.25 μg·kg-1·min-1.Cisatracurium besilate 0.1mg/ kg was added to maintain muscle relaxation,and BIS value was maintained at 40~60 during the whole operation.During the operation,HR,MAP,BIS,ACTH and Cor concentration were recorded at intervals(before anesthetic induction,skin incision immediately and after skin incision 15 min,30min,exploration,seam skin).Results:1 There was no significant difference between the two groups in the general data(P>0.05).2 There was no significant difference in BIS value between the two groups at each time point(P>0.05).3 Compared with group P,MAP was significantly lower at T3-5(P<0.05)and HR was significantly lower at T4 in group C(P<0.05).4 The concentration of ACTH and Cor were significantly lower at T1-5 in group C than group P(P<0.05).Conclusion:1 Compared with propofol,anesthesia with sevoflurane and propofol could lead to minor variation in hemodynamics,so it will be a good choice for clinical anesthesia.2 Compared with propofol,anesthesia with sevoflurane and propofol could have certain inhibitive effects on stress reaction of patients undergoing abdominal surgery.