Effect Of Different Depth Of Anesthesia On The Stress Response In Elderly Patients Undergoing Laparoscopic Cholecystectomy

BackgroundLaparoscopic cholecystectomy(LC),which is with small stimulate to body,less bleeding,less trauma,fast postoperative recovery,widely used in the treatment of elderly patients with gallbladder disease.With the continuous deepening of the basic and clinical research of anesthesia and the continuous changes of patient's disease spectrum and surgical spectrum,the content and value of the monitoring of anesthesia depth is constantly updated,and its clinical significance has become increasingly prominent.It is very important to select a appropriate anesthesia depth for improving the quality of anesthesia,reducing the risk of operation and promoting the postoperative recovery of patients.Although there are many reports about the elderly patients with LC in China and abroad,but the reports about the effect of different depth of anesthesia on stress response,immune function and cognitive function in the patients are few.ObjectiveTo investigate the effects of different depth of anesthesia on the stress response,immune function and cognitive function in the elderly patients with LC.Methods160 cases of patients who underwent elective laparoscopic cholecystectomy under general anesthesia in Henan Provincial People's Hospital were chosen,American Society of Anesthesiologists(ASA)I~II grade,aged 65~79 years old,BMI 20.3~26.8 kg/m2.According to inclusive and exclusive criteria,finally 147 patients ware included,82 patients were male and 65 were female,none of the patients eliminate.According to the random number table method,the patients were divided into d0,d1 and d2 group,eachgroup of 49 people.This study approved by hospital ethics committee,all the patients or their family members agreed and signed the informed consent.The patients were monitored by NT and the depth of anesthesia was maintained at the level of D0,D1 and D2 respectively.The MAP,HR and SpO2 of patients were recorded at different time points,such as before anesthesia induction(T0),tracheal intubation(T1),immediately after intubation(T2),surgery(T3),end of operation(T4),extubation time(T5);the cortisol,adrenocorticotropic hormone(ACTH),tumor necrosis factor-?(TNF-?)and C reaction protein(CRP)and CD4+,CD8+ levels were recorded at diffierent time points,such as before induction of anesthesia(t0),operation(t1),the end of operation(t2),1 d before operation(t3)and 4 d after operation(t4);the usage of propofol,fentanyl and vecuronium in operation were recorded;the Mini-mental State Examination(MMSE)scale and Montreal cognitive function Cognitive Assessment(MOCA)scale were evaluted at 1 d before operation and at4 d after operation.Results1 The differences between the MAP,HR and SpO2 of patients in 3 groups at T0 and T1 were not statistically significant(P>0.05);the MAP of patients in d0 group were obviously higher than it in d1 and d2 group at T2~T5 and the differences were statistically significant(P<0.05),but the differences between the MAP of patients in d1 and d2 were not obvious and the differences were not statistically significant(P>0.05);the HR of patients in d0 group were obviously higher than it in d1 and d2 group at T2~T4,and also higher than it in d2 group at T5,the HR of patients in d1 group were obviously higher than it in d2 group at T2 and T5,and the differences were statistically significant(P<0.05);but the differences between the SpO2 of patients in 3 groups at all time points were not statistically significant(P>0.05).2 The differences between the cortisol,ACTH,TNF-? and CRP levels of patients in3 groups at t0,t1 and t4 were not statistically significant(P>0.05);the cortisol level of patients in d0 group was obviously higher than it in d2 group at t2,and also obviouslyhigher than it in d1 and d2 group at t3,the cortisol level of patients in d1 group was obviously higher than it in d2 group at t2 and t3 and the differences were statistically significant(P<0.05);the ACTH level of d0 group or d1 group was obviously higher than it in d2 group at t2 and t3 and the differences were statistically significant(P<0.05);but the differences between the TNF-? of patients in 3 groups at all time points were not statistically significant(P>0.05);the cortisol level of patients in d0 group was obviously higher than it in d1 and d2 group at t2 and t3 and the differences were statistically significant(P<0.05).3 The differences between the CD4+ and CD8+ of patients in 3 groups at all time points were not statistically significant(P>0.05).4 Compared with group d0,the usage of propofol,fentanyl in d1 and d2 group were significantly increased,the difference was statistically significant(P<0.05),but the usages of propofol and fentanyl had no obvious difference between d1 and d2 groups,the difference was not statistically significant(P>0.05).There was not significant difference between the usage of vecuronium of 3 groups in the operation,the difference was not statistically significant(P>0.05).5 There were not obviously differences between MMSE and MOCA scores of patients in 3 groups at 1 d before operation and at 4 d after operation,the difference was not statistically significant(P>0.05).ConclusionCompared with D0 and D1,maintaining the anesthetic depth of elderly patients undergoing LC surgery at the level of D2 helps to maintain hemodynamic stability,reduce the stress response of patients.