| Objective Millions of patients with esophageal cancer need to receive surgeries every year in the world.Currently,general anesthesia has been widely used in esophageal cancer surgeries.General anesthesia can inhibit cortical projection system;nevertheless,it may not inhibit destructive stimulus induced by surgerical procedure.This may lead to adverse effects of postoperative recovery.Herein,it is important to investigate an effective anesthesia regimen,which can inhibit pain reaction efficiently,but also destructive stimulus induced by surgeries.Epidural anesthesia can effectively reduce stress response induced by surgeries.hence,this study is aimed to investigate effects of combined epidural-general anesthesia on postoperative recovery,especially for gastrointestinal function in patients with esophageal cancer undergoing endoscopic surgery.Methods Eighty patients with esophageal cancer undergoing selective endoscopic surgery were enrolled in this study in the First Affiliated Hospital of Anhui Medical University from November 2017 to April 2018.The patients were randomly divided into two groups according to random number table: Control group(C group)and Experimental group(E group),40 patients in each group.The patients in C group received general anesthesia alone,and combined epidural-general anesthesia was applied into E group.In E group,patients received epidural puncture at T8-9 and upper catheter insertion before induction of general anesthesia,and 0.25% ropivacaine was intermittent administrated,patients received epidural patient-controlled analgesia after surgeries.In C group,patients received patient-controlled intravenous analgesia after surgeries.Dosages of anesthetics in both of two groups were recorded,and arterial blood gas as well as hemodynamics in two groups was evaluated.The full recovery time,extubation time,the earliest time of exhaust after surgery,the earliest time of defecation after surgery,the earliest time of beginning liquid diet as well as the incidence of gastrointestinal complications(intestinal tympanites,nausea and vomiting)were compared between two groups.Results(1)There were no significant differences of gender ratios,ASA grade,NYHA grade,mean age,BMI and operation time as well as intravenous infusion volume between two groups(P>0.05).(2)Postoperative sodium levels and potassium levels in both group were significantly reduced compared with those before surgery,and postoperative chlorinum levels were significantly increased compared with that before surgery(P<0.05);compared with C group,postoperative sodium and chlorinum levels in E group decreased significantly,and postoperative potassium levels in E group increased significantly.(3)Hemodynamic parameters in both of two groups were reduced after anesthesia,but there were no significant differences between two groups after anesthesia.(4)Compared with C group,dosages of anesthetics(sufentanil,remifentanil,propofol and rocuronium)were significantly reduced in E group(P<0.05).(5)Compared with C group,the full recovery time and extubation time were significantly decreased in E group(P<0.05).(6)Comparison of recovery of gastrointestinal function between two groups: compared with C group,the earliest time of exhaust after surgery and the earliest time of defecation after surgery as well as the earliest time of beginning liquid diet were significantly reduced in E group(P<0.05).(7)Comparison of the incidence of gastrointestinal complications between two groups: compared with C group,the incidence of intestinal tympanites,nausea and vomiting were significantly decreased in E group(P<0.05).(8)Comparison of length of stay and costs between two groups: compared with C group,length of stay and costs reduced significantly in E group(P<0.05).Conclusion Combined epidural-general anesthesia can reduce amount of general anesthetics,significantly decrease the full recovery time,and improve recovery of gastrointestinal function as well as decrease gastrointestinal complications in Patients with esophageal cancer undergoing endoscopic surgery. |
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