Comparison Of Sevoflurane And Propofol Anesthesia During Endoscopic Submucosal Dissection In Elderly Patients With Colorectal Tumors

Background and objective: with the deepening of social aging,the incidence of digestive tract tumors is also increasing year by year,and most of the patients are over60 years old.Traditional laparotomy(including laparoscopic surgery)for the elderly patients with large trauma,high cost,long hospital stay,not conducive to patient recovery.In recent years,endoscopic submucosal dissection(ESD)has become the preferred treatment for early gastrointestinal tumors.ESD is a kind of minimally invasive surgery with precise operation and strict requirements for surgical conditions.ESD surgery is completed immediately after tumor resection and wound hemostasis.Without the procedure of traditional abdominal suture,anesthesiologists are often unable to predict the time to stop anesthesia in advance,which is likely to cause the delay of waking up.Due to the decline of physiological function,the sensitivity of elderly patients to intravenous anesthesia drugs is increased,so the elderly patients are at high risk of anesthesia outside the operating room.It is of great significance for elderly patients to choose an appropriate anesthesia method and ensure the stability of ESD during operation,timely and high-quality recovery after operation.Propofol has the advantages of quick onset and quick metabolism,and is popular in the anesthesia outside the surgery room.Sevoflurane has the advantages of rapid awakening,no liver and kidney metabolism,and mild cardiovascular inhibition,but it is rarely used in outdoor anesthesia.In order to find the most appropriate anesthesia method for this type of surgery,this study explored the application effect of sevoflurane and propofol in ESD surgery of colorectal tumors in elderly patients,and compared the safety,anesthesia recovery time,complication rate,patient satisfaction and other aspects of the application of these twodrugs,so as to provide theoretical basis for clinical work.Methods: this study was a prospective randomized controlled trial.According to the inclusion criteria,60 elderly patients(aged > 60 years old)who completed Colorectal ESD surgery in First affiliated Hospital of Dalian Medical University from October2017 to November 2018 were selected and divided into sevoflurane group and propofol group by random number method,30 patients in each group.Sevoflurane group was induced by sevoflurane inhalation(tidal volume method),combined sufentanil and cis-atracurium were inserted into the laryngeal mask,and sevoflurane combined with remifentanil was maintained.The propofol group was induced by propofol combined with sufentanil and cis-atracurium,and propofol combined with remifentanil was used for maintenance.Systolic blood pressure,diastolic blood pressure,heart rate,blood oxygen saturation,difference between maximum and minimum mean arterial pressure,and difference between maximum and minimum heart rate were observed and recorded at each time point.The total duration of anesthesia,duration of surgery,duration of polypectomy,induction duration,duration of awakening,duration of PACU residence,and polypectomy speed were recorded.Patient satisfaction,intraoperative adverse events,surgical complications,postanesthesia complications,and length of hospital stay were recorded.Spss23.0 software was used to analyze and compare the experimental data.Results :(1)systolic blood pressure,diastolic blood pressure and heart rate of patients in the two groups showed transient decrease after induction,but the decrease amplitude of S group at time T2,T3 and T4 was significantly smaller than that of P group(P <0.01).Systolic blood pressure,diastolic blood pressure and heart rate of patients in the two groups all returned to T1 level at T5,with no significant difference(P > 0.05).Two groups of patients with ? MAP and ? HR have obvious difference(P < 0.01).(2)there was no significant difference in operation duration and anesthesia duration between the two groups(P > 0.05).The induction duration in group S was significantly longer than that in group P(P < 0.01),and the awakening duration and PACU residence duration in group P were significantly longer than those in group S(P < 0.01).There was no significant difference in the rate of polypectomy between the two groups(P > 0.05).(3)two groups of patients with perforation,bleeding,dizziness,headache,nausea and vomiting,postoperative cognitive dysfunction occurrence had no difference(P > 0.05),the incidence of intraoperative hypotension S group was obviously less than P group(P< 0.01),the art center rate difference between the two groups(P > 0.05),after pulling a laryngeal mask SpO2 < 92% P than S group(P < 0.05).(4)there was no difference in the dose of sufentanil and remifentanil between the two groups(P > 0.05),the frequency and dose of ephedrine atropine in the S group was significantly lower than that in the P group(P < 0.01),and the dose of cis-atracurium and neostigmine in the P group was significantly higher than that in the S group(P < 0.01).(5)there was no difference in operative satisfaction,patient satisfaction and length of stay between the two groups(P > 0.05).Conclusion: both sevoflurane and propofol can be used safely for ESD anesthesia in elderly patients.The induction time of sevoflurane was longer than that of propofol,but the recovery time and the retention time of PACU were shorter than that of propofol group.There was no significant difference between total anesthesia duration and operation duration.The hemodynamics of sevoflurane induction and maintenance anesthesia were more stable in elderly patients undergoing Colorectal ESD surgery under general anesthesia.