FAST-TRACK ANESTHETIC TECHNIQUES: EFFECTS OF COMBINED EPIDURAL ANALGESIA WITH TIVA ANAESTHESIA ON INTRAOPERATIVE HEMODYNAMICS, DRUG CONSUMPTION, COST AND SIDE EFFECTS IN HIGH-RISK MAJOR ABDOMINAL SURGERY
FD.GEYİK
1, TA.AYAZOĞLU
2, A.ÖZENSOY
2, F.ÖZDEMİR
2
KARS DEVLET HASTANESİ 1
KARTAL KOŞUYOLU YÜKSEK IHTISAS EĞITIM VE ARAŞTIRMA HASTANESI 2
In this prospective, randomized, double-blind study, we investigated the effect of combined epidural analgesia with TİVA and TİVA on the intraoperative hemodynamic response , induction doses (IDs) , maintenance doses (MDs), drug consumption , recovery ( evaluated by using the bispectral index [BIS] ), and patient satisfaction ,cost.
This study consisted of 60 adults, ASA physical status III undergoing major abdominal surgery lasting >4 h.
Patients were divided into 2 groups of 30 each. An epidural catheter was placed between T12- L1 in all patients. Depending on the group allocation (Group E), 0.166% bupivacaine +10 µg/mL fentanyl (bolus 8- 10ml) firstly was administered as a bolus. Patients in the control group (Group C) received epidural normal saline (NS) as the same bolus volume. Induction of anesthesia was performed with IV remifentanil 0.5µg/kg and propofol titrated to achieve BIS between 40–50. Endotracheal intubation was facilitated by the IV administration of rocuronium 0.6 mg/kg and patient’s lungs were ventilated with 50% air in oxygen. After intubation, infusion of propofol 1% was titrated to maintain BIS between 40–50. After intubation In Group E 0.1% bupivacaine +2 µg/mL fentanly received by an infusion at 0. 15 ml x kg(-1) x h(-1) via the epidural catheter and Group C received epidural NS as same infusion rate .The Induction Doses ( IDs: BIS :45) and Maintenance Doses (MDs: BIS: 40–50) of propofol , the incidence of hemodynamic abnormalities and recovery (BIS,80) and extubation times, side effects and complications were recorded.
In epidural analgesia + TIVA group, intraoperative MAP values were significantly lower than those in TIVA anesthesia group (p<0.05). Changes in HR and SPO2 remained non-significant levels in both groups (p> 0.05). Time of extubation, time of eye opening with audible warning and time of verbal response was significantly lower in epidural + TIVA group than those in TIVA anesthesia group.
Total anesthetic drug consumption was significantly higher in TIVA group than those in epidural + TIVA group (p <0.05). Return of gastrointestinal function, side effects and satisfaction values were similar between groups (p> 0.05).
In high risk, major abdominal surgery, The combination of total iv anesthesia with epidural analgesia compared with the total iv anesthesia, we concluded that intraoperative hemodynamics is more stable, recovery is faster, drug consumption and cost are less, however, side effects and satisfaction levels are similar between groups.
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