The Effect Of General Anesthesia Combined With Epidur Alanesthesia And PCEA On The Early Post-operative Cognitive Function In Elderly Patients

【Object】To compare the effect of general anesthesia combined with epidural anesthesia+post-operative patients controlled epidural analgesia (PCEA) with general anesthesiaalone+post-operative patients controlled intravenous analgesia (PCIA) and generalanesthesia combined with epidural anesthesia+post-operative patients controlledintravenous analgesia (PCIA) as regards post-operative cognitive function among theelderlypatients received open radical gastrectomy (ORG). And to provide a noveltheory of a more suitable anesthesia and analgesia protocol for elderly patientsreceivingsurgery in midsection.【Methods】1.90ASA I~III grade elderly patients that aged over65who underwent ORGin Fuzhou General Hospital from March2013to January2014were recruited in thestudy. The written informed consent was obtained from the subjects, and theexperiment was permitted by Hospital Ethics Committee.2. According to the table of random number, the patients were into three groups:individual general anesthesia+PCIA (Group A), general anesthesia combined withepidural anesthesia+PCIA (Group B) and general anesthesia combined with epiduralanesthesia+PCEA(Group C).0.375%ropivacaine were administered epidural inGroup B and Group C.3. Cognitive function was assessed1d before operation and on the6h,12h,2d,3d and5dafter operation, by the Mini-Mental State Examination test(MMSE). HRandMAP were recorded during the different peri-operative periods, i.e.10min before induction of anesthesia (T0),1h after skin incision (T1),1min after abdominalclosure(T2), and the moment of extubation (T3). Blood samples were collected fromthe central venous to detect the plasma levels of glucose and cortisol before inductionand24h post-operative. Blood samples were collected from the central venous todetect the concentrations of serum protein S-100β、NSE and TNF-α byELISA. Theconsumption of (SEVO)and norepinephrine(NE)were recorded. Pain intensity wasassessed by usingVAS at6h,12h and24h after operation.【Results】1. General conditions: there were no significant differences in age, sex, ASAgrade, BMI, operation duration and pre-operative cognitive function among threegroups.2. Incidents of POCD:at6h and12h after operation,Group C was lower thanGroup A and Group B. On2d post-operation, Group C was lower than Group A. On3d and5d post-operation, Group B and Group C were lower than Group A.3. Intra-operative Hemodynamic: Group A changed greater than Group B andGroup C, especially at T2and T3.4. SEVOconsumption: Group A was more than Group B and Group C.5. NE consumption: Group B and Group C were more than Group A.6. Plasma levels ofglucose and cortisol: compared with the baseline ofpre-operative, three groups were all increased. Group A had significant increasecompared with Group B and Group C.7. Concentrations ofserum TNF-α: compared with the baseline of pre-operative,three groups were all increased. Group A had significant increase compared withGroup B and Group C.8. Concentrations ofserumS-100β and NSE: compared with the baseline ofpre-operative, three groups were all increased.Group A had significant increase ofS-100βcompared with Group B and Group C. there were no significant differences ofNSE in three groups. 9. VAS score: Group C was lower than Group A and Group B at6hpost-operation. Group B and Group C was lower than Group A at12h post-operation.There were no significant differences in three groups at24h post-operation.10. Spearman correlation analysis showed thatthe rates of POCD was positivelycorrelated with the SEVOconsumption, the VAS score, the glucose and cortisol levelsat24h post-operative, the S-100β concentrations at24h post-operative,whilenegatively correlated with thestability of hemodynamic and the NE consumption.【Conclusion】1. Anesthesia and ORG, in a manner, impact the cognitive function in elderlypatients. Compare with single general anesthesia+PCIA and general anesthesiacombined with epidural anesthesia+PCIA, general anesthesia combined withepidural anesthesia+PCEA can minimize the impaction.2. General anesthesia combined with epidural anesthesia+PCEA could inhabitthe harm information up-transmit from spinal to brain, and effectively block surgicalstress responses. Meanwhile, general anesthesia makes patients unconscious duringthe entire procedure, that will be beneficial to eliminate the psychological stress. Thusinhibit the neuroinflammation responses, and stabilize the function of central nervoussystem, decrease the cerebral injury.