Clinical Observation On Combined Spinal-epidural Anesthesia And LMA General Anesthesia On Total Hip Arthroplasty In Plateau

Objective: To explore the effect of general anesthesia and combinedspinal-epidural anesthesia with LMA general anesthesia to the cardiovascularstress reaction, anesthesia recovery and visual analogue scale after operation,and to provide theoretical basis for patients with total hip arthroplasty in plateau.Methods: A total of patients with54patients with hip arthroplasty, who visitedour hospital in July2013`-December2013, were randomly divided intoControl Group and Observation Group. Cases in Control Group receivedgeneral anesthesia, and cases in Observation Group received combinedspinal-epidural anesthesia with LMA general anesthesia. Systolic bloodpressure (SBP), diastolic blood pressure (DBP), heart rate (HR) andoxyhemoglobin saturation (SpO2) were determined before anesthesia (T0), atintubation (Tth1), at5min after intubation (T2),10thmin after intubation (T3), atskin incision (Td4), at1sthour after operation (T5), at2nhour after operation(T6), at end of the operation (T7), at the end of operation (T8), at extubation (T9),at5thmin after extubation (T10), at10thmin after extubation (T11), and the meanarterial pressure and heart rate-blood pressure product (RPP) were calculated.The time to respiration recovery, eye-opening, extubation and orientationrecovery were recorded and the visual analogue scale were compared at the1st,2nd,4th,12th,24thand48thafter operation.Results:①The SBP，DBP and MAP were significantly different in both groups at T0(P>0.05); the SBP in Control Group was significantly higher thanthat in Observation Group at T1, T2, T4, T9, T10and T11(P<0.05or P<0.01); theDBP and MAP in Observation Group were significantly higher than those inControl Group at T1, T4, T9and T10(P<0.05or P<0.01);②The HR weresignificantly different in both groups at T0(P>0.05)；the HR in Control Groupwas significantly higher than that in Observation Group at T1, T2, T4, T9and T10(P<0.05or P<0.01); the SpO2in both groups were not significantly different atT0, T1, T2, T3, T4, T5, T6, T7, T8, T9, T10and T11；③The RPP were significantlydifferent in both groups at T0(P>0.05)；the RPP in Control Group wassignificantly higher than that in Observation Group at T1, T2, T4, T9, T10and T11(P<0.05or P<0.01)；④The time to respiration recovery, eye-opening,extubation and orientation recovery were respectively (18.64+4.84) min,(15.27+3.56) min,(21.42+4.58) min and (35.76+6.24) min, which wereshortened compared to those in Control Group with significance in statistic(P<0.01)；⑤There were46.43%of patients who suffered dysphoria inanesthesia recovery period, which was lower than that in Control Group withsignificance in statistic (P<0.05)；⑥The VAS were not significantly different inboth groups at T0(P>0.05), and the VAS in Observation Group wassignificantly lower than that in Control Group at T1, T2, T4, T9and T10withsignificance in statistic (P<0.05or P<0.01). Conclusion: Combinedspinal-epidural anesthesia with LMA general anesthesia has the advantage ofstable hemodynamics, rapid revival after operation and less complications inpatients with total hip arthroplasty in plateau, worthy be recommended in clinic.