Effect Of Anesthetic Management On Intraoperative And Postoperative Complications In Elderly Patients With Coronary Heart Disease Undergoing Noncardiac Surgery

Objective:The purpose of this study was to investigate the effects of three different anesthetic methods on intraoperative and postoperative complications in elderly patients with coronary heart disease undergoing noncardiac surgery.Methods:The subjects of this study were 67 elderly patients with coronary heart disease who were scheduled for lower abdominal surgery including 39 males and 28 females.The age of the patients was 65⁸5years old,with an average age of 72.49±5.45 years old.The ASA physical status was II or III.In the 67 patients,there were 28 cases with hypertension,23 cases withdiabetes,17 cases with arrhythmia（atrial or ventricular arrhythmia,sinus tachycardia or sinus bradycardia,first degree atrioventricular block and atrial fibrillation）,12 patients with chronic obstructive pulmonary disease（COPD）.At the same time,there were 3cases with old cerebral infarction,3 cases with old myocardial infarction,3cases with Alzheimer’s syndrome in the 67 patients.According to the comprehensive assessment of patients’ preoperative condition,while meeting the requirements of surgery,the anesthetic methods were divided into 21 cases of combined spinal and epidural anesthesia（CSEA）,23 cases of general anesthesia（GA）,and 23 cases of general-epidual combined anesthesia（GECA）.Three groups of patients in age,gender,BMI index,ASA grade and preoperative complications had no significant difference（P>0.05）.MAP、HR and S_PO₂ were recorded in the GA group and GECA group at different time points:after admission of the OR（T₀）,before intubation（T₁）,3mins after intubation（T₂）,5mins after intubation（T₃）,immediately after the skin cutting（T₄）,30 mins after the start of the operation（T₅）,and at the end of the operation（T₆）.While in the CSEA group,MAP、HR and S_PO₂ were recorded at the following time points:after admissionoftheOR（T₀）,beforeanesthesia（T₁）,3minsafter injection（T₂）,5minsafterinjection（T₃）,immediatelyaftertheskin cutting（T₄）,30 mins after the start of the operation（T₅）,and at the end of the operation（T₆）.The number of cases of intraoperative and postoperative complications in three different anesthetic methods and the corresponding treatment measures were recorded at the same time.Operation time,blood loss,urine volume and fluid infusion of the patients were recorded at the end of operation.Results:In this study,there were no deaths in 67 elderly patients with coronary heart disease.In all the subjects,there were 26 cases of significant fluctuation ofblood pressure（over 20%of the MAP baseline value）and13 cases of arrhythmia,4 cases of postoperative pneumonia,1 cases of postoperative cognitive dysfunction,1 cases of cerebral infarction occurred fifth days after surgery.In terms of hemodynamics,the MAP and HR of T₂and T₃ in the CSEA group were significantly lower than those of T₁（Ρ﹤0.05）,while there is no significant difference in the MAP and HR of T4^T6 compared with T1（Ρ>0.05）;in the GA group,MAP and HR of T₂ and T₃ were significantly higher than those of T₁（Ρ﹤0.05）,while there is no significant difference in the MAP and HR of T4^T6 compared with T1（Ρ>0.05）;there was no significant difference in MAP and HR at all the other time points compared with T₁ in the GECA group（Ρ>0.05）.In the general anesthesia group,the complication rate of blood pressure rise（over 20%of the baseline value of MAP）was the highest（43.5%）.The most common occurrence in the CSEA group was intraoperative blood pressure drop（28.6%）and heart rate slow（23.8%）.Conclusion:1.For the elderly patients with coronary heart disease undergoing noncardiac surgery,patients receiving general-epidual combined anesthesia were more stable in hemodynamics and had lower incidence of arrhythmias and cardiovascular complications.2.The incidence of postoperative complications is affected by a variety of factors.Comprehensive preoperative risk assessment and intraoperative precise anesthesia management can help reduce the incidence of postoperative complications such as cerebral infarction,pneumonia and cognitive dysfunction.