| Objective:To observe and compare, The effects of sevoflurane combined with parecoxib sodium,sevoflurane combined with sufentanil and etomidate combined with sufentanil on hemodynamics and stress response of the elderly patients during the induction of general anesthesia.Methods:Sixty ASA I-II patients aged 65-75 yr undergoing general anesthesia for elective laparoscopic cholecystectomy or appendectomy were randomly divided into 3groups(n=20each). Sevoflurane combined with dynastat(group A), sevoflurane combined with sufentanil(group B)and etomidate combined with sufentanil(group C). Group A:give dynastat(0.6mg/kg) firstly, inhale 8% sevoflurane, give Cisatracurium(0.15mg/kg) by intravenous injection; Group B:inhale 8% sevoflurane, give sufentanil(0.3ug/kg) by small pot, cisatracurium(0.15mg/kg) by intravenous injection; Group C:give sufentanil(0.3ug/kg)by small pot, etomidate(0.2mg/kg) by intravenous injection,cisatracurium(0.15mg/kg) by intravenous injection. Tracheal intubation was performed when three groups patients were giving muscle relaxant after 3min. The anesthesia was maintained with propofol, remifentanil, atracurium. Recording systolic blood pressure(SBP), diastolic blood pressure(DBP), heart rate(HR), pulse oxygen saturation(SP02) and anesthesia induction time before induction(To), immediately after the induction before intubation(T1), after intubation l-3min(T2), 5min(T3), 10min(T4);recording blood glucose and plasma hydrocortisone concentrations before induction(To), after intubation 5min(T3), after intubation 10min(T4); to record adverse reactions such as injection pain, laryngospasm, coughs during intubation; nausea and vomiting,restlessness during awakening period and so on.Results:(1)The gender,age, height, body weight were no significant difference(P>0.05).(2)Hemodynamic changes:Comparison in the group: compared with To, group Aand B:the SBP and DBP of T1,T3,T4 point; group C: the SBP and DBP of T1 point decreased,the SBP and DBP of T2 point increased, there was a significant difference(P<0.05).group A:the HR of T1 T3,T4 point decreased,group B: the HR of T1 point decreased and T2 point increased,there was a significant difference(P<0.05); group C: the HR of T1, T4 point decreased and T2 point increased, there was a significant difference(P<0.05).Comparison between groups: Compared with the group C, group A and B: the DBP of T1 point increased,the SBP and DBP of T2 point decreased; group A:the HR of T2, T3, T4 point, group B: the HR of T2 point decreased significantly(P<0.05), compared with the group B: group A:the HR of T3 point decreased significantly(P<0.05).(3) Blood glucose and cortisol concentration changes: Blood glucose and cortisol concentration of three groups of T0 point, there were no significant difference.Compared with T0, blood glucose and cortisol concentration of group Aand B decreased significantly in T3,T4 point(P<0.05);compared with the group C, group A of T3, T4 point, group B of T4 point, blood glucose decreased obviously; group A of T4 point, group B of T3, T4 point, cortisol decreased obviously,there were a significant difference(P<0.05).(4) Adverse reaction: three groups of patients were choking cough, but no laryngospasm, there was no significant difference(P>0.05). Group C the incidence of injection pain was obviously higher than other two groups(P<0.05); group B, the incidence of agitation was obviously higher than that of A and C, the incidence of nausea and vomiting in group C was lower than that of group A and B(P<0.05).Conclusion:Compared with etomidate, sevoflurane anesthesia induction is more suitable for the elderly patients; compared with sufentanil, parecoxib sodium could effectively restrain the stress reaction during tracheal intubation and prevent some of the adverse reaction caused by sevoflurane,such as nausea, vomiting, restlessness and so on. So sevoflurane combined with parecoxib sodium can be safe and effectively for the elderly patients during the induction of anesthesia. |
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