The Influence Of Sevoflurane Anesthesia To Elderly Coronary Heartdisease Patients On Perioperative Hemodynamics And Myocardial

Objective: To investigate the influence of sevoflurane on perioperative Hemodynamics and Myocardial in elderly coronary heartdisease patients undergoing noncardiac surgery.Methods: We enrolled 100 elderly patients with coronary heart disease received Elective laparoscopic surgery in our hospital from June 2015 to March 2016.Patients were randomly assigned to sevoflurane group（S）or propofol group（P）,maintained of anesthesia with sevoflurane or propofol.Bispectral index（BIS）was used to monitor the depth of sedation in the intraoperative period.We recorded heart rate（HR）,mean artery pressure（MAP）,cardiac output（CO）,cardiac index（CI）,systemic vascular resistance（SVR）,left cardiac work（LCW）before induction of anesthesia(T_a0),before intubation(T_a1),1 minute after intubation(T_a2),at the start of surgery(T_a3),before extubation(T_a4)and 5 minutes after extubation(T_a5),measured troponin I（c TnI）and creatine kinase isoenzyme（CK-MB）at the time before induction of anesthesia(T_b0),end of surgery(T_b1),12 hours(T_b2),24 hours(T_b3),48 hours(T_b4)after the suegery,and compared the Intraoperative remifentanil dosage and postoperative visual simulation score（VAS）in two groups.Results:1.There was a significant decrease in HR,MAP,SVR,LCW at T_a1,T_a3 in both groups（P<0.05）.In group P,CO at T_a3 and CI at T_a2,T_a3 were lower than T_a0（P<0.05）;HR at T_a1,MAP at T_a2 were lower in group S than in group P（P<0.05）.There was no significant difference between the two groups with respect to CO,CI,SVR,LCW at each point（P>0.05）.2.The level of cTnI and CK-MB in postoperative period were significantly increased comparing with T_b0 in two groups.However,the level of CK-MB reached the peak at T_b3,descended at T_b4,the level at T_b4 was still higher than T_b0.Compared with group P,cTnI and CK-MB in group S at T_b2,T_b3,T_b4 was significantly lower（P<0.05）,which had the statistical significance.3.The dosage of Intraoperative remifentanil in group S were lower than group P obviously（P<0.05）.But the postoperative visual simulation score（VAS）in two groups has no significant difference.Conclusion: Sevoflurane anesthesia has slight effect on the hemodynamic factors,reduces myocardial injury and surgical stress during the perioperative period,has better myocardial protection in elderly coronary heartdisease patients undergoing noncardiac surgery.We suggest the widespread usage of it in clinic.