| Background:Total knee replacement surgery patients are often elderly, often accompanied by diabetes, high blood pressure, coronary heart disease, lung infections, poor lung function, lumbar degenerative diseases and coagulation disorders and other diseases, which make them intolerant to anesthesia and surgery. Selecting an appropriate kind of anesthesia for elderly patients to adjust and suppress the occurrence of perioperative stress response is essential, which is also important for perioperative physiological stability.For elderly patients undergoing unilateral lower limb surgery we usually choose spinal anesthesia, which can reduce the incidence of intraoperative myocardial ischemia, postoperative pulmonary atelectasis, pulmonary infection, hypoxemia, pulmonary embolism and deep vein thrombosis. These characteristics such as rapid onset, low plasma concentration, good analgesic effect, rapid postoperative recovery and suppressing the stress response of lower extremities surgery have made it be the most major lower extremity anesthesia in our country. Although spinal anesthesia has so many advantages mentioned above, it also has many problems for the special group of elderly patients:drop in blood pressure, difficulty in epidural puncture, puncture complications and bleeding problems caused by anticoagulation. Therefore general anesthesia is always clinically chosen. But endotracheal intubation and extubation would cause a strong stress response to elderly patients with chronic diseases, which cause many adverse effects. Lower extremity nerve block is widely used in the elderly lower limb surgery. It has little impact to respiration and circulation. But the block is often insufficient. Lower extremity nerve block combined with general anesthesia and the use of the LMA could solve the problem.Aims:To observe the hemodynamics, stress response, analgesia and the thrombosis.A comprehensive comparison of anesthesia used in total knee replacement surgery is proceeded.To provide a reference for total knee arthroplasty.Methods:We enrolled62patients undergoing TKA. The patients ranged in age from55to72years old, weight58to86kg, ASA Ⅰ-Ⅱ. The patients were randomly divided into two groups:simple laryngeal mask anesthesia group (L) and lower extremity nerve block combined with laryngeal mask anesthesia group (G group),31cases in each group. Detect and detailed record (record once every5minutes) systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MBP) and heart rate (HR). Collect venous blood at the time of baseline values (TO)before induction of anesthesia, the end of surgery (T3), six hours in surgery (T5) and surgery24hours (T6) to detect the inflammatory factor interleukin-6(IL-6) and cortisol (cortisol); recorded operative time, tourniquet time, intraoperative general anesthetic dosage; do postoperative pain score using VAS.Results:Two groups of patients have no significant difference in sex, age, weight and operative time (P>0.05).Compared with group L, the amount of propofol used in group G is significantly reduced, the difference is statistically significant (P<0.05). SBP:L group at surgical incision instant point (T1) is higher than G group, the difference was statistically significant (P<0.05). HR:surgical incision instant point (Tl),30minutes of surgery (T2) point, group L is higher than group G the difference was statistically significant (P<0.05). Interleukin-6(IL-6), cortisol (COR):group L are higher than group G at the time of T0,T3,T5and T6, the difference was statistically significant. The pain grading score:group L is significantly higher than that in group G (P<0.05). Conclusion:For elderly patients undergonging total knee arthroplasty, lumbar plexus-sciatic nerve block combined with laryngeal mask anesthesia has more hemodynamic instability, more effective inhibition of perioperative stress response and better postoperative analgesia compared to general anesthesia alone using laryngeal mask. |
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