| Background and Aims During the perioperative period of patients undergoing gastrointestinal surgery,anesthesia induction,endotracheal intubation,and cardiovascular stress caused by intraoperative pulling of the gastrointestinal tract may lead to drastic fluctuations in hemodynamics,thereby affecting myocardial function and increasing the risk of anesthesia and surgery,especially in elderly patients.Maintaining hemodynamic stability,especially during endotracheal intubation and intraoperative exploratory traction,is important in elderly patients with increased sensitivity to anesthesia and decreased organ reserve and compensatory capacity.At present,several clinical methods are used to reduce the cardiovascular stress response caused by anesthesia and surgical operation in patients undergoing gastrointestinal surgery,such as esmolol,labelolol,nitroglycerin,clonidine and other drugs to regulate the cardiovascular system function.In addition,the use of lidocaine in laryngopharyngeal topical anesthesia also reduced the cardiovascular stress response during tracheal intubation.In surgical procedures such as intraoperative exploration of the gastrointestinal tract,it is common to increase the dose of anesthetic drugs to suppress the cardiovascular response.However,the results of these techniques are not always satisfactory.The stellate ganglion is formed by the fusion or abutting of the inferior cervical ganglion and the first thoracic ganglion.The postganglionic fibers are widely distributed in the glands of the head,neck,face,upper limbs,lungs,trachea,heart and blood vessels.Stellate ganglion block(SGB)has been used to control pain and treat a variety of diseases caused by sympathetic overexcitation.It also improves hemodynamics and promotes the regulation of the nervous,immune and endocrine systems.In addition,as a sympathetic nerve block,the sympathetic nerve excitation caused by surgery may inhibit the parasympathetic nerve,thereby inhibiting gastrointestinal function,and SGB may improve postoperative gastrointestinal function and promote its recovery.Therefore,this study was to investigate the effects of SGB on anesthesia,intraoperative central vascular stress response and postoperative gastrointestinal function recovery in elderly patients undergoing gastrointestinal surgery.The SGB group and normal saline group(control group)were set respectively,and the parameters of cardiovascular response were monitored and analyzed,and the time of first postoperative exhaust and the incidence of intestinal obstruction were recorded.Methods Eighty elderly patients who underwent gastrointestinal surgery were selected.An anesthesia assistant,who was not involved in the subsequent study,performed randomization using a computer-generated table and patients were divided into two groups(n=40): the SGB group underwent SGB with 0.25% ropivacaine at the level of right sixth cervical spine under ultrasound guidance before anesthesia and the control group(C group)was injected with the same amount of normal saline at the same site.Preoperative patients with record in general data and related information,record the patient T0(home),T1(before intubation),T2(after intubation),T3(cut skin),T4(probe pull gastrointestinal)moments of product of heart Rate,mean arterial pressure,heart Rate and systolic blood pressure(Rate pressure product values,RPPs)changes,and record the operation time and patients with sufentanil usage.Postoperative follow-up included extubation time,PACU residence time,sufentanil consumption in PACU,postoperative nausea and vomiting(PONV),visual analogue scale(VAS),need for rescue analgesics,first exhaust time,postoperative hospital stay,and incidence of intestinal obstruction.Results In this study,a total of 86 elderly patients with elective gastrointestinal surgery were selected,and a total of 80 patients were included for result analysis after excluding non-conforming cases.There were no significant differences in preoperative general information,operative time,intraoperative amount of sufentanil postoperative tracheal catheter removal time,VAS score,need for rescue analgesics,PONV,postoperative incidence of intestinal obstruction and length of hospital stay between 2 groups(P >0.05).At T4,RPPS > 12000 in group C was significantly increased at T2 and T4 compared with baseline value and SGB group,and the difference was statistically significant(P < 0.05).The residence time of PACU and the first postoperative exhaust time in SGB group were significantly lower than those in C group(P < 0.05).Conclusion Ultrasound guided stellate ganglionic block can reduce anesthesia and intraoperative hemodynamic fluctuations in elderly patients undergoing gastrointestinal surgery,inhibit cardiovascular stress response,and promote postoperative gastrointestinal function recovery in patients,which is a good auxiliary anesthesia method. |
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