ABSTRACT
Objective To compare the application effects of different drug administration modes under continuous epidural anesthesia in elderly patients undergoing total hip replacement.Methods One hundred and twelve ASA Ⅱ-Ⅲelderly patients undergoing elective total hip replacement,55 males and 57 females,aged 75-91 years old,were randomly divided into the group A and B,56 cases in each group.After continuous epidural puncture success at L2-L3,the test dose of 2 ％ lidocaine 3 mL was injected,according the anesthesia plane,additional 2 ％ lidocaine 3-5 mL was injected,the group A adjusted the anesthesia plane to T10,after fixation,epidural continuous infusionof 2 ％ lidocaine 3 5 mL/h was performed according to the patient's condition;the group B adjusted the anesthesia plane to T10,after fixation,according to patient's condition epidural injection of 2 ％ lidocaine 3-5 mL/h was injected by several times.The two groups were given vasoactive drugs dopamine when necessary during operation.Mean arterial pressure(MAP),heart rate (HR) and pulse oxygen saturation (SPO2) at entering the operation room,30 min after medication injection,skin incision,postoperative 1 h and end of operation were recorded in the two groups.The anesthesia plane,anesthetic drug dosage,anesthesia effect and fotal dosage of dopamine were recorded in the two groups.Results Blood pressure after epidural drug administration in the two groups were significantly reduced,while the blood pressure after intraoperatively administrating additional drug in the group B was significantly decreased compared with the group A(P＜0.05).The anesthesia plane in the group A was more stable than that in the group B (P＜0.01),moreover the dosage of anesthetic drug was decreased significantly (P＜0.05).The intraoperative total amount of dopamine in the group A was obviously less than that in the group B (P＜0.05).Conclusion Micropump continuous drug administration during continuous epidural anaesthesia has little influence on the patient's hemodynamics than discontinuous single drug administration.In the condition without affecting the anesthesia effect,the anesthesia plane is more stable,the anesthesia drug dose can be significantly decreased,which is conducive to maintain the circulation stable and increase perioperative safety.
ABSTRACT
Objective To investigate the effect of small dose methoxamine on parturient′s circulation stability and neonate during anesthesia of cesarean section .Methods Two hundreds and eighty-five cases of cesarean section under combined spinal epi-dural anesthesia in the hospital from January 2014 to June 2016 were selected and divided into 3 groups .The group A was intrave-nously injected by 1 mg of methoxamine hydrochloride instantly after anesthesia ,the group B by 2 mg ,while the group C was intra-venously injected by 2 mL of normal saline .The basic values at calmness after entering the operation room (T0 ) ,systolic blood pres-sure (SBP) and heart rate(HR) at horizontal position immediately after anesthesia(T1 ) ,at 1 min(T2 ) ,5 min(T3 ) after anesthesia , at 1 min(T4 ) before fetus delivery and at 5 min after fetus delivery (T5 ) were recorded ,and neonatal umbilical arterial blood pH value ,blood gas indicators and Apgar score at 1 min after delivery were also recorded .The parturient appearing the adverse reac-tions such as nausea and vomiting during operation were observed .Results HR at T2 in the group B and C was significantly in-creased ,then decreased significantly (P<0 .05) ,while which at T1 in the group A began to decrease and HR at the various time points of T2 -T4 were significantly lower than those in the group B and C ,moreover had no big fluctuation (P<0 .05);SBP at T2 in 3 groups was significantly decreased compared with that at T0 (P<0 .05) ,but SBP at the various time points of T2 -T4 in the group A were significantly higher than those in the group B and C (P<0 .05);umbilical vein blood pH ,blood gas indexes and Ap-gar score at 1 min after birth had no statistically significant differences between the group A and B (P>0 .05) ,but which in the group C were significantly lower than those in the group A and B (P<0 .05);the adverse reaction rate in the group A was 2 .11% , which was significantly lower than 9 .47% in the group B and 13 .68% in the group C (P<0 .05) .Conclusion Small dose of me-thoxamine can effectively maintain the parturient′s hemodynamic stability after combined spinal epidural anesthesia in cesarean sec-tion and has no adverse effect on neonate .