The influence of age on hemodynamics and the dose requirements of propofol and buprenorphine in total intravenous anesthesia

A retrospective study was performed to determine the influence of age on hemodynamics and awakening time in total intravenous anesthesia (TIVA) with propofol and buprenorphine for spinal surgery. Twenty patients (26-79 yr) were studied and allocated into following four groups by age: 26-49 yr, 50-59 yr, 60-69 yr, and elderly 70-79 yr. All patients were premedicated with midazolam (2.5-5 mg) i.m. Anesthesia was induced (60-180 ml.h-1) and maintained (20-60 ml.h-1) with propofol infusion with 40% oxygen in air, added with vecuronium and one single dose of buprenorphine (0.08-0.2 mg; 1.37-2.63 micrograms.kg-1) before incision. Mean arterial pressure was stable and did not differ in four groups. Heart rate was decreased (P < 0.01) in the elderly group compared with the group younger than 50 yr. Bradycardia (below 50 beat.min-1) occurred in 60% of the elderly group. An adequate dose of buprenorphine (microgram) was proposed as: 208 - 1.8 x age (yr) + 0.3 x weight (kg) (r = 0.90, P < 0.01). The induction and maintenance rates (ml.h-1) of propofol were decreased with age and increased with weight (P < 0.05). However, the maintenance dose of propofol (3.9-8.5 mg.kg-1.h-1) did not correlate with age. Awakening time was prolonged (P < 0.05) in the elderly group (17.0 +/- 7.2 min) as compared with the group of younger than 50 yr (8.0 +/- 3.9 min). The three patients requiring postoperative analgesics were younger than 60 yr. This study suggests that we should reduce the dose of buprenorphine with age in TIVA using propofol. About 50% of the dose given to the patient younger than 50 yr was considered adequate in the elderly group.     

The changes in hemodynamics and dose requirements in total intravenous anesthesia using propofol and buprenorphine

A retrospective study was performed to evaluate the changes in hemodynamics and dose requirements in total intravenous anesthesia (TIVA) using propofol and buprenorphine without (Group S: spinal surgery (3-6 h), n = 8, 28-79 Y) or with (Group A: abdominal surgery (5-10 h), n = 15, 36-83 Y) epidural anesthesia. All patients were premedicated with midazolam i.m. (2-5 mg). Anesthesia was maintained with a single dose of buprenorphine (Group S: 1.9 +/- 0.4 micrograms.kg-1, Group A: 2.0 +/- 0.5 micrograms.kg-1), propofol infusion and vecuronium with 40% oxygen in air. Group A was supplemented with continuous epidural anesthesia using 2% mepivacaine. In Group A, mean arterial pressure (MAP) and heart rate remained stable after the start of surgery. However, in Group S, 2 hours after the start of surgery MAP increased (P < 0.05) and remained elevated (P < 0.05) at higher levels than those in Group A. The maintenance dose of propofol in Group A (4.0 +/- 1.1 mg.kg-1.h-1) was significantly smaller than in Group S (6.5 +/- 0.9 mg.kg-1.h-1). In both groups, infusion rates of propofol were unchanged from 1 hour after the start to the end of surgery. Infusion rates of mepivacaine (5.2 +/- 0.9 ml.h-1) were unchanged following the increase 2 hours after the start of surgery. Awakening times were within 25 min (Group S 11.3 +/- 7.2 min vs Group A 14.7 +/- 7.3 min). There was no awareness during anesthesia in either group. The results suggest that additional continuous epidural anesthesia in TIVA would be useful to reduce propofol dose, to stabilize hemodynamic state and to obtain rapid recovery in anesthesia of long duration.     

Recovery from total intravenous anesthesia with propofol and buprenorphine

A retrospective study was performed to evaluate recovery from total intravenous anesthesia (TIVA) with propofol and buprenorphine for various types of surgery. The patients of the study were divided into two groups; Group A: n = 85, age 66 +/- 12 Y, duration 282 +/- 102 min, with epidural block and Group B: n = 56, 52 +/- 20 Y, 172 +/- 90 min, without the block. All patients were premedicated with intramuscular midazolam (1-5 mg). Anesthesia was maintained with propofol infusion with 40% oxygen in air, and an intravenous bolus dose of buprenorphine (0.11 +/- 0.03 mg). Muscle relaxation was obtained by intravenous vecuronium. The patients of Group A were supplemented with continuous epidural anesthesia using 2% mepivacaine. The maintenance dose of propofol (Group A: 4.5 +/- 1.2 mg.kg-1.h-1, Group B: 7.0 +/- 1.8 mg.kg-1.h-1) and temperature at the end of surgery decreased significantly with age. Awakening time in all patients was 12.3 +/- 7.4 min and it was correlated significantly with age and hypothermia, but not correlated with the maintenance dose or duration of propofol infusion. In short-duration surgery (within 2 hours, n = 36) awakening time was correlated with neither age nor temperature. There was no difference in awakening time between genders. Requirement for analgesics within 20 hours was 18.8% in Group A and 14.3% in Group B. Four patients (2.8%) reported dreaming, but none of the patients recalled the intraoperative events. We suggest that in elderly patients the reduction of intravenous anesthetics, maintenance of normothermia and short-duration surgery would result in rapid recovery in TIVA.     

Use of propofol and buprenorphine for total intravenous anesthesia

A study was carried out in 47 patients undergoing general surgery and elective gynecological surgery under totally endovenous general anesthesia. For this purpose, propofol and buprenorphine were used in controlled ventilation with oxygen and air, totally excluding the use of nitrous oxide and halogenate vapours. The following parameters were measured to evaluate the state and depth of anesthesia: arterial pressure (systolic, mean, diastolic), heart rate, sweating, lacrimation (Evan's PRST). The awakening from anesthesia was evaluated using Steward's test. The results of monitoring show that the method represents a valid alternative to anesthesia using inhalatory techniques. Nonetheless, the Authors underline the need for further research on the subject.     

A clinical dose finding study of propofol in continuous total intravenous anesthesia]

Total intravenous anesthesia (TIVA) is recommended in view of avoiding air pollution. However, intermittent administration of anesthetic agents has a disadvantage of delayed emergence time. We have suggested continuous TIVA with propofol, ketamine, vecuronium and buprenorphine (PKBp), and reported that the elder or the patients anesthetized for a long time show delayed emergence from continuous TIVA. In this study, after induction with propofol, ketamine, vecuronium and buprenorphine, the subjects were maintained with continuous intravenous administration of propofol corresponding to the age using twice step down method with ketamine (240 micrograms.kg-1.h-1), vecuronium (80 micrograms.kg-1.h-1) and buprenorphine (0.4 microgram.kg-1.h-1). Emergence was evaluated from the 2nd step down of propofol to awareness. There was a linear relationship between the emergence (2nd step down time of propofol to awareness) (Y) and the anesthetic time (X); Y = 0.175X + 3.00. We conclude that the last 1/6 (= 0.175) of anesthetic time is the point to reduce maintenance doses of propofol to achieve more rapid emergence.     

Anesthetic management of a patient with dilated cardiomyopathy under total intravenous anesthesia with propofol and ketamine combined with continuous epidural analgesia

We report our experience with total intravenous anesthesia (TIVA) with propofol and ketamine combined with continuous epidural analgesia in a 72-year-old-male patient with dilated cardiomyopathy scheduled for a total prostatectomy. After premedication with atropine 0.5 mg and pethidine 35 mg, anesthesia was induced with ketamine 50 mg, fentanyl 0.1 mg and using a step down method of propofol (6-->4-->2 mg.kg-1.hr-1). After hemodynamic parameters had been stabilized, the trachea was intubated. Then, 1.5% lidocaine 6 ml was injected through an epidural catheter, placed at the L 1-2 intervertebral space. Anesthesia was maintained with continuous infusion of propofol 1 mg.kg-1.hr-1 and ketamine 1 mg.kg-1.hr-1, and continuous epidural analgesia with 1.5% lidocaine 2 ml.hr-1. Hemodynamics remained stable throughout the operative procedure. No postoperative complications occurred. TIVA with propofol and ketamine in combination with epidural analgesia is useful for patients with dilated cardiomyopathy in order to maintain stable hemodynamics during anesthesia.     

雷米芬太尼复合丙泊酚静脉麻醉的临床应用

目的观察雷米芬太尼复合丙泊酚静脉麻醉的效果。方法全身麻醉下腰椎手术患者60例,随机均分为雷米芬太尼复合丙泊酚静脉麻醉组(Ⅰ组)和静吸复合麻醉组(Ⅱ组)。雷米芬太尼和丙泊酚的负荷量分别为1μg/kg和1mg/kg,雷米芬太尼以0.5μg·kg-1·min-1速率输注。麻醉中通过增减雷米芬太尼0.1μg·kg-1·min-1输注速率调整麻醉深度。丙泊酚按5∶4∶3方案输注,即5mg·kg-1·h-1输注10min,4mg·kg-1·h-1输注10min,20min后3mg·kg-1·h-1恒速输注。观察两组气管插管反应、麻醉效果、苏醒质量。结果两组麻醉效果相同,均可抑制气管插管反应(P<0.01),且Ⅰ组较Ⅱ组明显(P<0.05)。Ⅰ组苏醒质量较Ⅱ组好(P<0.01),不良反应较Ⅱ组高(P<0.01),术中无知晓。结论雷米芬太尼复合丙泊酚用两个注射泵静脉麻醉,采用负荷量加两种以上速率输注全凭静脉麻醉简便易行。     

胸段硬膜外复合静脉全麻与全凭静脉麻醉在开胸手术中的比较

目的 比较胸段硬膜外复合静脉全麻与全凭静脉麻醉对开胸手术患者血流动力学、麻醉药维持剂量、术后苏醒、躁动及疼痛的影响.方法 64例择期行剖胸手术患者,ASA Ⅱ级～Ⅲ级,采用完全随机设计的方法分为2组.A组:胸段硬膜外复合静脉全麻组,患者预先用10 ml 0.25%布比卡因和0.1 mg芬太尼硬膜外给药.术中硬膜外0.25%布比卡因和芬太尼10μg/ml,5 ml/h复合丙泊酚维持.B组:全凭静脉麻醉组,丙泊酚-端芬太尼全凭静脉麻醉.观察并记录不同时间点2组心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、所需麻醉维持药量、术毕清醒及出现疼痛时间.结果 2组患者各观察点血流动力学变化比较,差异无统计学意义;胸段硬膜外复合静脉全麻组麻醉维持不需要静脉镇痛药瑞芬太尼和肌松药阿曲库铵,只需复合充分的丙泊酚镇静,就能满足手术需求;术后苏醒早;拔管时间(11±4)min,相对于全凭静脉麻醉组(23±16)min明显缩短(P<0.05):躁动例数显著减少;术后出现疼痛时间(7.4±2.6)min相对于全凭静脉麻醉组(0.5士0.3)min明显延长(P<0.01).结论 胸段硬膜外复合静脉全麻用于开胸手术快通道麻醉是一种安全、经济、有效并有利于患者术后恢复的麻醉方法.     

A comparison of fentanyl and buprenorphine in total intravenous anesthesia using propofol during spinal surgery

A retrospective study was performed to compare the hemodynamic effect and postoperative pain relief of fentanyl (Group F, n = 11) and buprenorphine (Group B, n = 11) in total intravenous anesthesia (TIVA) using propofol during spinal surgery. All patients were premedicated with midazolam (3-5 mg) i.m. Anesthesia was maintained with propofol infusion, and increments of fentanyl or single dose of buprenorphine with 40% oxygen in air. Total doses of fentanyl and buprenorphine were 7.6 +/- 1.0 micrograms.kg-1 and 2.0 +/- 0.4 micrograms.kg-1, respectively. Maintenance doses of propofol (Group F: 5.5 +/- 0.8 mg.kg-1.h-1, Group B: 5.9 +/- 1.1 mg.kg-1.h-1) and vecuronium were not significantly different. Mean arterial pressures from 2 hours after incision to the end of surgery were elevated significantly in Group F than in Group B. Recovery time (Group F 12.5 +/- 6.1 min vs Group B 11.8 +/- 6.1 min) and extubation time (Group F 19.5 +/- 10.3 min vs Group B 15.0 +/- 7.0 min) were not different. At the end of anesthesia, seven patients in Group F and one patient in Group B (P < 0.01) complained of severe pain. All patients in Group F, and only two in Group B (P < 0.02) received analgesics within 20 hours. Neither nausea nor respiratory depression was found in both groups. This study suggests that buprenorphine would provide a more stable hemodynamic state and better postoperative pain relief than fentanyl in TIVA using propofol.     

硬外复合静脉麻与气管全麻在小儿腹腔镜疝手术的比较

目的对比分析研究硬膜外复合丙泊酚静脉全麻与气管内全麻在小儿腹腔镜疝囊高位结扎手术中的优缺点。方法ASAⅠ-Ⅱ级择期行腹腔镜疝手术患儿40例,年龄在1～12岁,随机分为硬膜外复合丙泊酚静脉全麻组（E组）和气管内插管全麻组（G组）。观察气腹前,气腹后5min,10min,15min,放气后5min的MAP,HR,SpO2,PH,PaCO2,和术毕恢复时间,比较两者麻醉的费用。结果与气腹前比较,E组MAP,HR变化无显著性差异（P〉0．05）,G组显著升高（P〈0．05）。两组患儿气腹15min后PaCO2均显著升高（P〈0．05）。停气腹后恢复至气腹前水平。E组麻醉苏醒时间明显快于G组,术后恶心呕吐发生率差异无显著性。E组麻醉费用比G组明显减少。结论硬外复合丙泊酚静脉全麻在小儿腹腔镜疝手术中,可有效抑制应激反应且经济安全,术毕苏醒时间快,苏醒质量好。     

Dose requirements of pentazocine during abdominal surgery in total intravenous anesthesia using propofol

BACKGROUND: To determine the dose requirements of pentazocine when administered as a single bolus dose in total intravenous anesthesia with propofol for abdominal surgery. METHODS : One hundred and fifty-six patients scheduled for abdominal surgery were analyzed retrospectively. Patients were classified into three groups according to duration of the operation ; under 120 min (Group 1, n=87) ; 120-240 min (Group 2, n=56) ; over 240 min (Group 3, n=13). Anesthesia was induced with propofol using target controlled infusion method, and was maintained with propofol infusion, pentazocine as a single dose before incision, and intermittent administration of vecuronium with 40% oxygen in air. RESULTS: Dosage of pentazocine was significantly increased according to length of the operation. The maintenance doses of propofol were not different among the three groups. Awakening time in about 80% of patients in each group was within 15 minutes. There are no severe complications. CONCLUSIONS : Total intravenous anesthesia with propofol and pentazocine is useful to stabilize hemodynamics and to achieve rapid recovery. For the operation within 120 min, 0.7 mg x kg(-1) of pentazocine is necessary whereas 0.8 mg x kg(-1) of pentazocine is needed in the operation of 120-240 min.     

Successful management of a patient with myotonic dystrophy under total intravenous anesthesia with propofol, remifentnil and rocuronium bromide, combined with epidural anesthesia

In general anesthesia for a patient with dystrophia myotonica (DM), respiratory depression and muscle weakness by opioid, as well as prolongation of the effect of muscle relaxant are seen postoperatively. Therefore it is desirable to choose agents with short duration of action and to dose these medicines to the minimum. We report a case of a 45-year-old woman with DM who underwent laparotomy for uterine cancer under general anesthesia combined with epidural anesthesia. Epidural catheter was placed from T 11-12, and anesthesia was inducted with propofol and remifentanil (RF). We administered rocuronium bromide (RB) 5 mg while watching TOF ratio with a muscle relaxation monitor (TOF-Watch). T1 became 0 after giving a dose of 10 mg, and intubation was performed. We maintained anesthesia by propofol and RF combined with epidural anesthesia. TOF ratio was restored to around 80% 90 minutes after RB administration, but we did not give supplemental doses because the operation went well smoothly. Recovery was smooth and fast. The respiratory depression and the muscle spasm were not noticed. RB and RE both with short duration of action, are useful in anesthesia management in DM cases.     

A new method of continuous propofol infusion for total intravenous anesthesia]

Total intravenous anesthesia (TIVA) is recommended to avoid air pollution. However, intermittent administration of anesthetic agents has a large disadvantage of delayed emergence time. We suggested continuous TIVA with propofol, ketamine, vecuronium and buprenorphine (PKBp), and reported that maintenance with continuous intravenous administration of propofol corresponding to the age associated with ketamine (240 micrograms.kg-1.h-1), vecuronium (80 micrograms.kg-1.h-1) and buprenorphine (0.4 microgram.kg-1.h-1) brought rapid emergence and that the last 1/6 of anesthetic time was the point to reduce propofol maintenance dose. In this study, we maintained anesthesia with continuous intravenous administration of propofol using twice step down method every one hour. We conclude that the reduction of propofol maintenance dose for every 1/6 in one hour produces fewer dropout cases.     

Changes in SpO2 during total intravenous anesthesia combined with propofol and SpO2 during one-lung anesthesia ventilation

We retrospectively examined SpO2 during one-lung anesthesia (OLA). One hundred and fifty patients of ASA 1 or 2 for thoracoscopic surgery were anesthetized with propofol and fentanyl (n = 93) or pentazocine (n = 57) and mechanically ventilated with FIO2 = 0.6 in the lateral decubitus position. Twelve patients (8%) developed SpO2 < or = 95% in the first 20 minutes of OLA. It has been reported that hypoxemia during OLA occurs in 13-40% of patients under inhalation anesthesia with FIO2 = 1.0. Our results show the total intravenous anesthesia using propofol is useful to maintain SpO2 during OLA. SpO2 during OLA tended to fall in the patients for right side operation, with lower SpO2 during two-lung ventilation and higher body mass index (BMI). However BMI has never been reported as a predictor of hypoxemia during OLA. A gravity-dependent mechanism is considered to be more responsible for the dependent regional volume reduction during OLA in patients in the lateral decubitus position.     

硬膜外复合丙泊酚静脉麻醉对老年人脑电双频谱指数和心率变异的影响

目的　探讨老年人硬膜外复合丙泊酚静脉麻醉中脑电双频谱指数 (BIS)和心率变异性(HRV)的改变。方法　择期腹部手术病人 4 0例 ,按年龄分成年轻组和老年组。诱导前T8～ 1 1 穿刺置管 ,咪唑安定 0 1mg/kg、丙泊酚 1mg/kg、维库溴铵 0 1mg/kg、芬太尼 3μg/kg诱导后插管 ,丙泊酚4mg·kg 1 ·h 1 恒速泵入维持麻醉 ,术中每 4 5～ 6 0min硬膜外追加局麻药 3～ 5ml,静注芬太尼 1～2 μg/kg、维库溴铵 0 0 5mg/kg。记录入室后、诱导后、插管后、术中及清醒睁眼时的BIS、低频与高频比值 (LF/HF) ;记录手术时间、术中用药情况、术中发生低血压和心动过缓次数。结果　两组平均年龄分别为 (31 4 4± 6 6 9)岁和 (71 0 0± 5 1 5 )岁 ,P <0 0 1。手术时间分别为 (1 96 1 1± 36 94 )和(2 0 8 34± 2 4 0 0 )min ,P >0 0 5。用药情况及各时点BIS值未见显著性差异 ;组间诱导和插管后的LF/HF有显著性差异 (P <0 0 1 ) ;两组低血压发生率分别是 2 0 %和 5 5 % ,P <0 0 5 ;心动过缓发生率分别是 1 0 %和 2 0 % ,P >0 0 5。结论　BIS可较好地反映硬膜外复合丙泊酚静脉全麻的镇静深度 ,且不受年龄影响 ,心率变异的LF/HF可较好地反映老年人围麻醉期间自主神经功能的均衡性 ,为老年人围术期的管理提供有益的指     

七氟醚复合麻醉与丙泊酚全凭静脉麻醉对老年患者腹腔镜手术PND的影响

目的:比较七氟醚复合麻醉与丙泊酚全凭静脉麻醉对老年患者腹腔镜手术围手术期神经认知障碍（perioperative neurocognitive disorders,PND）的影响。方法:选取2019年9月—2020年9月在十堰市人民医院普通外科行腹腔镜手术的患者98例,年龄60~75岁,ASA分级Ⅰ、Ⅱ级,采用随机数字...     

全凭静脉麻醉和硬膜外麻醉对重度子痫前期产妇颅内压的影响

目的 剖宫产围术期使用超声通过测定接受全凭静脉麻醉或硬膜外麻醉的重度子痫前期孕妇的视神经鞘直径(ONSD),间接评估两种麻醉方法对重度子痫前期产妇颅内压的影响.方法 选择拟行剖宫产术的重度子痫前期产妇60例,年龄20～45岁,ASA Ⅲ级.随机分为两组:全凭静脉麻醉组(GA组)和硬膜外麻醉组(EA组),每组30例.GA...     

艾司洛尔或尼卡地平联合容量填充对全凭静脉麻醉丙泊酚用量的影响

目的 探讨艾司洛尔或尼卡地平联合诱导期容量填充对全凭静脉麻醉丙泊酚用量的影响.方法 择期行脊柱手术的患者36例,随机均分为三组:艾司洛尔组(E组)于诱导前2 min静注艾司洛尔1 mg/kg,继之以100 μg·kg-1 ·min-1微量泵输注至术毕;尼卡地平组(N组)于诱导前2min静注尼卡地平10 μg/kg,继之以1 μg·kg-1 ·min-1微量泵输注至术毕;生理盐水组(C组)于相同时间点给予等量生理盐水.三组患者均于给予血管活性药物开始20 min内快速静滴羟乙基淀粉130/0.4 10ml/kg行容量填充.麻醉诱导和维持均采用TCI丙泊酚和舒芬太尼,调节丙泊酚效应室浓度使术中BIS值维持在40～60.记录丙泊酚用量,清醒和拔管时间.结果 与C组比较,E组和N组丙泊酚用量显著减少(P＜0.05),清醒和拔管时间明显缩短(P＜0.05).结论 艾司洛尔或尼卡地平联合诱导期容量填充不仅有利于维持血流动力学的平稳,而且能够明显减少全凭静脉麻醉丙泊酚用量,缩短清醒和拔管时间.     

异丙酚复合芬太尼静脉麻醉用于腹腔镜胆囊切除术的临床研究

目的:研究异丙酚芬太尼静脉麻醉在腹腔镜胆囊切除术的应用,效果,并与安氟醚吸入麻醉相比较,探索适于短效腹腔镜手术安全有效的静脉麻醉。方法:将22～78岁,ASAⅠ～Ⅱ级胆囊择期手术120例,随机分为2组,静脉组和吸入组各60例,静脉组静脉注射异丙酚1.5mg/kg,芬太尼3～5ug/kg,维库溴铵0.06～0.1mg/kg。吸入组用2.5％硫贲妥钠5mg/kg。琥珀胆碱1.5mg/kg,气管内插管持续吸入0.5％～2.5％安氟醚,取出胆囊时均使用阿托品1mg,新斯的明2mg,拮抗残余肌松作用。结果:静脉酚组患者术后苏醒迅速且完全,苏醒后较吸入组患者安静,80％患者术后2h才感觉疼痛,只有20％患者感觉疼痛,术后无需应用镇痛药。结论:异丙酸诱导后心率明显低于吸入组,但大部分患者不用处理,3～5min后恢复正常。异丙酚复合芬太尼静脉麻醉可产生良好的麻醉效应,循环维持稳定,苏醒迅速完全,术后可产生良好的镇痛效果,恶心呕吐发生率低。     

瑞芬太尼联合硬膜外麻醉在胃癌根治术中的应用及对血流动力学的影响

目的研究瑞芬太尼联合硬膜外麻醉在胃癌根治术中的应用效果以及对患者血流动力学的影响。方法选取2018年1月至2019年12月海南西部中心医院收治的100例行胃癌D2根治手术的患者作为研究对象。按照麻醉方式不同分为两组,各50例。联合组采用瑞芬太尼联合硬膜外麻醉,对照组仅行全身麻醉。比较两组患者手术相关指标、血流动力学指标、应激反应指标、出室前Steward苏醒评分、术后24 h疼痛评分(VAS)及并发症发生情况。结果联合组丙泊酚、瑞芬太尼用量少于对照组,拔管时间、苏醒时间优于对照组(P<0.05);两组手术时间、术中出血量、术中输液量及各时间点麻醉深度指数(CSI)差异无统计学意义。两组心率(HR)、平均动脉压(MAP)、收缩压(SBP)、舒张压(DBP)麻醉前差异均无统计学意义,但麻醉后60 min、拔管后10 min时联合组明显低于对照组(P<0.05)。术后3、7 d时联合组应激指标皮质醇(Cor)、去甲肾上腺素(Ne)、总抗氧化能力(TAC)水平明显低于对照组(P<0.05)。联合组Steward苏醒评分及术后24 h VAS评分均优于对照组(P<0.05)。结论瑞芬太尼联合硬膜外麻醉应用于胃癌根治术能够促进患者苏醒,维持患者术中血流动力学稳定,降低应激反应,缓解术后疼痛,安全可行,可在临床推广。