胸段硬膜外阻滞对老年胸科手术患者苏醒期躁动的影响

目的 观察胸段硬膜外阻滞对老年患者行胸科手术时全麻苏醒期躁动(emergence agitation,EA)的影响.方法 择期行胸科手术的老年患者40例,ASA Ⅱ～Ⅲ级.其中男23例,女17例,年龄65岁～78岁,均为食道癌和肺癌患者.将40例患者用完全随机法分为两组(每组20例),分别给予全麻复合硬膜外麻醉(A组)...

The effects of thoracic epidural block on emergence agitation in elderly patients undergoing thoracic surgery

Objective To explore the effects of thoracic epidural block on emergence agitation (EA) in emergence period in elderly patients undergoing chest surgery. Methods Forty ASA Ⅱ -Ⅲ patients (23 male, 17 female) aged 65 y-78 y undergoing esophagectomy or lobectomy were randomized to receive either general combined thoracic epidural anesthesia (group A, n=20) and pure general anesthesia(group B, n=20). Thoracic 5-6 or 6-7(T5-6 or T6-7) vertebral clearance for puncture and epidural catheter was placed before general anesthesia in group A.A test dose of 4 ml 1.5% lidocaine was given. When correct positioning of the epidural catheter was confirmed, general anesthesia was induced with etomidate 0.2 mg/kg-0.3 mg/kg, each patient was lower than 500 ml and the time of operation was within 3 hours. Hemodynamics were maintained stable and muscle relaxation was the same in both groups. Patients of both groups received 2 ug/kg fentanyl intravenously before end of operation and patient controlled intravenous analgesia (PCIA). The restlessness score (RS), extubation time, general anesthesia dosage were recorded. Results In group A, the mean score of RS in group A was 15 while that of Group B was 32. Time of extubation of Group A was shorter than that of group B (5.1 min vs. 11.6 min and the general anesthesia dosage were significantly less than those in group B (P=0.006 ). 5 patients in group A developed dangerous EA whereas only 1 patient in group A (P=0.002). Conclusion Thoracic epidural block significantly reduces agitation during emergence in elderly patients undergoing chest surgery.