Clinical Observation Of Laparoscopic Total Hysterectomy In Obese Patients Under Different Anesthesia Methods

Background and objectiveThe increasing prevalence of obesity worldwide has led to a surge in the number of bariatric surgical patients requiring perioperative anesthesia.Fat accumulation and abnormal distribution in obese patients can cause a series of metabolic diseases.The metabolic dysfunction of adipose tissue causes the body to be in a long-term chronic inflammatory state.Injury stimulation such as surgery can further enhance the inflammatory response,which is not conducive to the postoperative recovery of obese patients.General anesthesia is routinely used in the operation of obese patients,and drug administration according to kilogram of body weight may lead to excessive drug dose and even toxic reactions.In addition,the re-release of anesthetic drugs accumulated in adipose tissue may lead to delayed recovery of patients and even reentry into anesthetic state,which brings some challenges to clinical anesthesia management.Epidural anesthesia combined with general anesthesia is a kind of multimodal analgesia program,which can effectively relieve pain and accelerate recovery.However,the feasibility and effectiveness of epidural anesthesia combined with general anesthesia for obese patients have not been verified yet.Therefore,this study mainly explores the effect of total laparoscopic hysterectomy under different anesthesia methods for obese patients,in order to provide reference for perioperative anesthesia methods for obese patients.MethodA total of 120 obese female patients,aged 32-64 years,with ASA grade Ⅰ～normal,BMI≥28kg·m-2,were selected from the First Affiliated Hospital of Zhengzhou University from September 2018 to June 2020.The patients were divided into general anesthesia group(G group)and general anesthesia combined with epidural anesthesia group(QG group)by random number table method,with 60 patients in each group.Group G:Sufentanil 0.4μg·kg-1,Etomidate 0.3 mg·kg-1,cisatracurium 0.2mg·kg-1.QG group:epidural anesthesia was first administered:0.375%ropivacaine 15ml,followed by general anesthesia,and the induced dose was the same as group G.The heart rate(HR),mean arterial pressure(MAP),end expirational carbon dioxide(PETCO2)and airway pressure(Paw)after admission(T0),anesthesia induction time(T1),10min after pneumoperitoneum establishment(T2),10min after peritoneal closure(T3)and trachea catheter removal(T4)in 2 groups were compared and analyzed.The venous blood was collected Respectively after admission,postoperative 4,24,72h,adrenal cortical hormone is measured by ria method(COR),adrenocorticotropic hormone(ACTH),endothelin 1(ET-1)level,using commercial enzyme-linked immunosorbent assay kit measurement of tumor necrosis factor(TNF)-alpha,interleukin(IL)-6 and c-reactive protein(CRP)concentration and record.Visual analogue scale(VAS)score and ramsay sedation score were observed and recorded in the group 1,4,12,24 and 48h after surgery;The amount of remifentanil and propofol pumped intraoperatively,the number of postoperative analgesia pump press,patients’ satisfaction with anesthesia,and the incidence of postoperative nausea,vomiting and other adverse reactions(delayed recovery,respiratory depression,dizziness,headache,lumbosacral pain and mental symptoms)were compared and recorded.Besides,the extubation time,feeding time,bed time,and length of hospital stay were recorded.Result1.A total of 97 patients were finally included in the study,including 49 patients in the general anesthesia group(G group)and 48 patients in the general anesthesia combined with epidural anesthesia group(QG group).There was no statistical significance in the general information between the two groups(all P>0.05).2.There were no significant differences in HR and MAP between the two groups at T0 and T1(P<0.05).HR,MAP and Paw of QG group were lower than those of G group at T2 and T3(P<0.05).HR and MAP in QG group were lower than those in G group at T4(P<0.05).There was no significant difference in intraoperative PETCO2 between the two groups(P>0.05).3.Compared to post-entry,the serum levels of COR,ACTH,ET-1,TNF-α,TL-6 and CRP were increased 4 and 24h after operation(P<0.05);Compared to group G,the serum levels of COR,ACTH,ET-1,TNF-α,IL-6 and CRP were significantly decreased in QG group 4 and 24h after operation(all P<0.05).4.Compared with G group,VAS scores at 1,4,12,24 and 48h after surgery in QG group were significantly lower than those in G group(P<0.05);There was no significant difference in Ramsay score between the two groups(P>0.05).5.Compared with group G,the intraoperative dosage of remifentanil and propofol,the number of postoperative analgesia pump press,the incidence of postoperative 24h total nausea and vomiting was significantly decreased in group QG(all P<0.05).The anesthesia satisfaction and incidence of lumbosacral pain in QG group was significantly increased(all P<0.05);There was no statistical significance in the incidence of other adverse reactions(delayed awakening,dizziness and headache,respiratory depression,and mental symptoms)within 48 hours after surgery between the two groups(P>0.05).6.Compared with group G,the extubation time,feeding time,getting out of bed time and hospitalization time in group QG were significantly shortened(all P<0.05).ConclusionThe application of general anesthesia combined with epidural anesthesia during laparoscopic hysterectomy in obese patients can reduce the use of anesthetic drugs,make hemodynamics more stable,relieve the body’s stress response and inflammatory response,and relieve postoperative pain.Less adverse reactions,high satisfaction with anesthesia,which is conducive to shorten the length of hospital stay and accelerate the outcome and recovery of patients.