Combined epidural and general anesthesia in upper abdominal surgery for the elderly

Objective:To evaluate the efficacy of epidural anesthesia combined with general anesthesia in upper abdominal surgery for the elderly.Methods:Thirty elderly patients with ASA grade Ⅰ to Ⅱ scheduled for elective upper abdominal surgery,were divided randomizedly into the study group (the combined epidural and general anesthesia group) and the control group (the general anesthesia group).In both groups the general anesthesia was induced with intravenous midazolam 0.05 mg/kg,fentanyl 4 μg/kg,propofol 1 mg/kg and vecuronium 0.1 mg/kg,and was maintained with intravenous infusion of propofol 2-4 mg·kg -1 ·h -1 and intermittent bolus of vecuronium,fentanyl and/or inhalation of 0.5%-1% isoflurane.In study group,T_ 9-10 epidural blocking was performed before induction.Hemodynamics was measured and intraoperative awareness; postoperative restlessness and general anesthesia dosage were recorded.Serum concentration of cortisol,epinephrine and blood glucose was determined before anesthesia,after tracheal intubation,skin incision,1 hour after incision,and after tracheal extubation.Results:In control group,serum cortisol concentration at 1 hour after incision and after tracheal extubation was higher than the baseline levels,and increased significantly compared with those in the study group (P0.01).In study group epinephrine and glucose concentration at 1 hour after incision were higher than the baseline levels,and decreased significantly compared with those in control group (P0.01).In study group the increase of MAP and HR at skin incision,after tracheal extubation was significantly lower than those in the control group (P0.01).In study group postoperative restlessness and general anesthesia dosage were lower than those in control group(P0.01 and P=0.035).Conclusions:The combined epidural and general anesthesia can stabilize the hemodynamics,reduce the stress to the surgery,and can be more effectively and safely employed in upper abdominal surgery for the elderly.