Effects of Combined Epidural Analgesia with Total Intravenous Anesthesia on Risky Patients Underwent Major Abdominal Surgery
Tülin Akarsu Ayazoğlu1, Aynur Özensoy2, Fatih Doğu Geyik3, Muhittin Çalım4, Uğur Duman5, Mehmet Akif Candan6
1S.b. İstanbul Medeniyet Üniversitesi Göztepe Eğitim Ve Araştırma Hastanesi Department Of Anaesthesiology And Reanimation, Istanbul, Turkey.
2Kartal Kosuyolu High Speciality Training And Research Hospital, Department Of Anaesthesiology And Reanimation, Istanbul, Turkey.
3Kartal Lütfi Kırdar Training And Research Hospital, Department Of Anaesthesiology And Reanimation, Istanbul, Turkey.
4Bezmi Alem Vakıf University Department Of Anaesthesiology And Reanimation, Istanbul, Turkey
5Sevket Yilmaz Training And Research Hospital, Department Of General Surgery, Bursa, Turkey
6Rize State Hospital, Department Of Anaesthesiology And Reanimation, Rize, Turkey
Keywords: Epidural, Analgesia, Remifentanil, Bupivacaine, Fentanyl
Abstract
Background and Objectives: The aim of this study is to investigate the effects of combined epidural analgesia with total intravenous anaesthesia and only total intravenous anaesthesia on the different clinical parameters.
Methods: Sixty high risk patients undergoing a major abdominal surgical procedure were included in this prospective, double blind, randomized study. Induction of anaesthesia was performed with IV remifentanil 0.5µg/kg and propofol titrated to achieve bispectral index score between 40 and 50. After intubation; in Group E, 0.1% bupivacaine and 2 µg/mL fentanyl were administered by an infusion rate at 0. 15 ml/kg/h via the epidural catheter and Group C received epidural normal saline as same infusion rate.
Results: In group E, intraoperative MAP values were significantly lower than those in group C (p<0.05). Time of extubation, time of eye opening with audible warning and time of verbal response was significantly lower in group E than those in group C. Total anaesthetic drug consumption was significantly higher in group C than those in group E (p <0.05).
Conclusions: Based on lower requirements for propofol and remifentanil as well as the favourable effects on clinical parameters; we conclude that bispectral index score guided combined epidural with total intravenous anaesthesia is superior to solely total intravenous anaesthesia in this type of surgery.