Sevoflurane Combined With Different Doses Of Etomidate For Maintenance In General Anesthesia

Objective The aim of this subject was to evaluate the effect and adverse reaction of sevoflurane combined with different doses of etomidate on anesthesia maintenance,then to find the best combination,so as to provide reference for clinical applications.Method One hundred and twenty patients of American Society of Anesthesiologist physical status I or II,aged 20-60 yr,scheduled for elective non-cardiothoracic,non-neurological surgery under general anesthesia within 2 hours were chosen.They were divided into E1,E2,E3,and E4 groups randomly（30 patients in each group）.All the patients got into the operation room,blood pressure,heart rate,blood oxygen saturation,and bispectral index（BIS）were monitored.General anesthesia was induced with midazolam 0.03mg/kg,sufentanil 0.25ug/kg,rocuronium0.6mg/kg,and group E1,E2,E3 were given propofol 1-2mg/kg,group E4 was given etomidate 0.3mg/kg intravenous.After performed tracheal intubation,patients were mechanically ventilated immediately(（VT6⁸ml/kg,oxygen flow 2L/min）,maintained the end-tidal carbon dioxide between 35-45mmHg.Anesthesia was maintained with etomidate 5μg/kg·min in group E1,7.5μg/kg·min in group E2,10μg/kg·min in group E3,and 15μg/kg·min in group E4 respectively,In addition,groups E1,E2,E3with inhalation of sevoflurane,and four groups were infused with remifentanil0.06-0.1 ug/kg·min.Anesthetic depth was controlled within a bispectral index of40–60.Those measurements were observed:（1）.we recorded patients characteristics,include gender,age,body mass index,ASA ststus,duration of surgery,duration of anesthesia,consumption of etomidate,consumption of analgesic drugs,consumption of sevoflurane during surgery（when sevoflurane was inhalated,10 min after inhalated,when sevoflurane was stopped inhalation）,duration of sevoflurane inhalation.（2）.Mean arterial pressure and heart rate were recorded at:I₁--baseline,I₂--2 min after induction,O₁--skin incision,O₂--10 min after surgery,O₃--halfway through surgery,O₄--at the end of surgery,A₁--2 min after extubation.（3）.The maximum and the lowest mean arterial pressure,heart rate of the surgery were recorded.（4）.We recorded the consumption of vasoactive drugs.（5）.We recorded postoperative eye opening time,extubation time,and the incidence of postoperative side-effects,RSAS score,OAA/S score,VAS score.Results 1.There were no significant difference between the four groups with respect to age,BMI,ASA status,duration of surgery,duration of anesthesia,consumption of analgesic drugs,duration of sevoflurane inhalation（P>0.05）,sevoflurane inhalation in group E1,E2,E3 at the concentration of 0.6-0.8 MAC,0.5-0.7 MAC,0.3-0.5MAC,respectively.2.Compared with other three groups,the average arterial pressure in group E4 was significantly higher at I₂、O_3、O_4,（P<0.05）;At the time of O₁,patients in group E3 had a significantly lower blood pressure than group E1 and group E4（P<0.05）,and group E4 had a significantly higher blood pressure than group E2 and group E3（P<0.05）;there was no statistical difference between four groups at I₁ and A₁（P>0.05）.3.Compared with other three groups,patients in group E4 had a significantly higher heart rate at I₂,O₁,O2,O₄（P<0.05）;There was no significantly difference between the four groups at I_1、O_3、A₁（P>0.05）.4.The maximum mean arterial pressure and heart rate,there was no significant difference between four groups（P>0.05）.The minimum blood pressure in group E4was higher than other three groups（P<0.05）.The minimum heart rate in group E3 was lower than group E4（P<0.05）.5.The usage of vasoactive drugs in group E3 was lower than other three groups（P<0.05）.6.There was no significant difference between the four groups in the postoperative eye opening time（P>0.05）;Compared with other three groups,groups E3 exhibited shorter extubation time（P<0.05）.The incidence of nausea and vomiting was lower in group E2 and E3 than in group E1 and E4（P<0.05）;There was no significant difference between the four groups about the RSAS,OAA/S and VAS scores（P>0.05）.Conclusions The effect of etomidate combined with sevoflurane for maintenance of general anesthesia is superior to etomidate alone,with hemodynamics more stable.Furthermore,etomidate infused at the rate of 10ug/kg·min combined with0.3-0.5MAC concentration sevoflurane is much better.