Observation Of The Application Of Combined Anesthesia With Spontaneous Respiration In Elderly Patients Undergoing Intertrochanteric Fracture

Objective:To explore the feasibility and safety of combined anesthesia with spontaneous respiration in elderly patients with intertrochanteric fractures,as well as the impact on anesthesia recovery and postoperative pulmonary complications.Methods:Sixty-nine elderly patients?65-95 years old,ASA grade II-??who underwent PFNA?Proximol Femorol Nail Antirotation?at our hospital from October 2018 to July 2019 Randomly divided into three groups,Group A?experimental group?retained spontaneously breathing laryngeal mask general anesthesia combined with nerve block,group B?control group 1?mechanically ventilated laryngeal mask general anesthesia combined with nerve block,group C?control group 2?tracheal intubation general anesthesia,all patients underwent ultrasound-guided femoral nerve block?0.4%ropivacaine 20ml?combined with lateral femoral cutaneous nerve block?0.4%ropivacaine 10ml?,propofol was maintained by intravenous anesthesia under intraoperative BIS?40-60?monitoring.The vital signs,recovery time of anesthesia and complications of the three groups of patients before,during and after the operation were recorded.Results:1.A total of 69 patients completed the trial,23 in each of the A,B,and C groups.There was no significant difference in the basic information?age,gender,BMI value,ASA classification,preoperative complications?and related indexes?MAP,HR,SPO₂?before induction of anesthesia among the three groups?P>0.05?.2.Three groups of patients at intubation?T₁?,skin removal?T₂?,5 minutes after skin removal?T₃?,15 minutes after skin removal?T₄?,25minutes after skin removal?T₅?,after surgery?T₆?,There were no significant differences in HR,MAP,and SPO₂ between groups and between groups at 1h?T₇?,3h?T₈?,6h?T₉?,and 12h(T₁₀)after operation?P>0.05?;There were significant differences between the three groups of patients at different time points?T₁ to T₆?during the PetCO₂ group?P<0.05?.The value of PetCO₂ in group A was higher than that in groups B and C,but both were less than50mmHg.3.Three groups of patients stopped using anesthesia until BIS rose to90 hours?H₁?,stopped using anesthesia to body movement time?H₂?,stopped using anesthesia to extubation time?H₃?,and stayed in recovery room?H₄?The difference between pairwise comparisons was statistically significant?P<0.05?,and the recovery time was from short to long:Group A-B-C.4.There was no significant difference in oxygenation index?OI?between the three groups of patients before and at the time of PACU release?P>0.05?.5.There were no significant differences in the operation time,intraoperative blood loss,intraoperative use of propofol and dexmedetomidine,the satisfaction of the surgeon,the length of hospital stay,and complications?P>0.05?.;But the difference in the amount of sufentanil was statistically significant?P<0.05?:There was no significant difference between group A and group B?P>0.05?.Compared with group C,the amount of sufentanil in groups A and B The amount of nicotine was less,and the difference was statistically significant?P<0.05?.6.The VAS score before nerve block was significantly higher in the three groups than at each time point after the nerve block,and the difference was statistically significant?P<0.05?,but there was no significant difference between groups at each time point after the nerve block?P?0.05?.Conclusion:1.The combined anesthesia with spontaneous breathing is safe and feasible for elderly patients with intertrochanteric fractures,and it recovers faster than the control group.2.Whether the combined anesthesia with spontaneous breathing can reduce the incidence of postoperative pulmonary complications remains to be further studied.3.Compared with the tracheal intubation mechanical ventilation group,the amount of opioids used in the spontaneous breathing group is less.