Effects of General Anesthesia Combined with Epidural Block on Cardiovascular and Stress Response for Thoracic Surgery in Geriatric Patients / 中国医师杂志

ABSTRACT

Objective To study the effects of cardiovascular and stress responses and the feasibility during thoracic surgery for geriatric patients under general anesthesia combined with epidural block. Methods Thirty elderly patients ASAⅠ-Ⅱ, scheduled for elective thoracic surgery, were divided randomly into combined general and epidural anesthesia group(G+E)and general anesthesia group(G). In both groups general anesthesia was induced with propofol 1.5mg/kg, fentanyl 4?g/kg, atracurium 0.6mg/kg, and maintained with intravenous continuously of propofol 5～7 mg?kg -1 ?h -1 , intermittent iv bolus of fentanyl and atracurium. In group GE epidural was performed at T_ 5-9 and an epidural catheter was placed and 1% lidocain 5 ml was given before induction of general anesthesia, after intubation and remained the cardiovascular stable, 1% lidocain 5～10 ml was infused epidural space. Appropriate fentanyl was given before skin incision for analgesia. Blood samples were taken before anesthesia, 10 min, 30 min, 1 h, 2 h after skin incision and the end of surgery for determining of cortisol, norepinephrine(NE), epinephrine(E)and interleukin-6(IL-6); measured and recorded the mean artery pressure(MAP), heart rate(HR), general anesthetic dosage and the duration of postoperative revival. Results In group GE, serum cortisol at 10 min,30 min and 1 h after skin incision decreased significantly compared with those in group G( P