| Background: Our country has entered the aging society, and has a hugenumber of elderly people. The aging has developed rapidly. The data isexpected that there will be one elderly people per five on average in ourcountry until2045. According to statistics, more than half of the elderlypeople had experienced at least once operation before death. Because ofthe growth of the age of elderly patients, viscera function has differentdegrees of loss. And they also suffer several kinds of disease in thecardiovascular system, other chronic diseases, and surgical diseasewaiting to be solved. They can impact the drug distribution and metabolismof adverse effects, such as the higher incidence of perioperative periodcomplications. All of them could make the anesthesia of elderly patientsmore challenging.Fentanyl is a long-term opioid analgesic being one of the essentialmedicines in general anesthesia, widely applied to the induction ofgeneral anesthesia and postoperative analgesia and maintaining, etc. Butsome studies have shown that fentanyl is easy to accumulate in the bodytissues. After intravenous injection it can form the second peak of blooddrug concentration in90min. Most previous studies have tended to observethe influence of hemodynamic when fentanyl compounds other narcotic drugsor the different administration route of fentanyl (intravenous drugdelivery and intra-spinal canal). There hasn’t found the report ofresearch observing relevantly different dosage regimen of fentanyl duringoperations. Objective: This study was intended to observe the influence ofhemodynamic and postoperative revival of the elderly patients sufferedfrom abdominal surgery by intravenous general anesthesia, with differentdosage regimen of fentanyl, in order to guide the clinical medication.So we can provide a safe, smooth and comfortable anesthesia better toelderly patients.Methods: Made a choice of50cases of elderly patients suffered fromabdominal surgery(operation time is less than3h) by intravenous generalanesthesia during December2012～June2013in our hospital. Randomlydivided into2groups, one was given adequate fentanyl before the skinopening (early analgesia group), and the other one was given superaddition of fentanyl during operation (addition group).Observing thechange of intraoperative hemodynamics, awakening time and recoveryquality, pain and dysphoria after awake, the time staying inPost-anesthetic Care Unite (PACU), the total doses of maintaininganesthetics of the two groups.Results: Compared with early analgesia group, addition grouppresented significant hemodynamic fluctuations during endotrachealintubation and skin opening (P<0.05). The two groups showed no statisticaldifference of hemodynamic at the other time point (P>0.05). Earlyanalgesia group’s awakening time and PACU time significantly shorterthan addition group (P<0.05). Two groups of patients’ incidence of painand dysphoria after awake showed no statistical difference (P>0.05). Thetotal doses of maintaining anesthetics of the two groups showed nostatistical difference (P>0.05).Conclusion: When confronting elderly patients suffered fromabdominal surgery(operation time is less than3h) by intravenous generalanesthesia, injecting adequate fentanyl before the skin opening with noadditional injection during the operation, not only can better sustain the hemodynamic stability during endotracheal intubation and skinopening,but also make no effect on the intraoperative and postoperativeanalgesia. It can also shorten the recovery time and the PACU time, improvethe quality of recovery. It is a safe and appropriate dosage regimen. |
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