Safety of epidural combined with small-dose intravenous anesthesia during total knee arthroplasty in elderly patients with hypertension / 中国组织工程研究

ABSTRACT

BACKGROUND:Elderly hypertensive patients often associated with organ and tissue ischemia. Al kinds of risks are easy to appear in the process of undergoing arthroplasty. To ensure the smooth operation and to improve the safety of the surgery treatment, it is needed to choose an appropriate mode of anesthesia. OBJECTIVE:To explore the application security of epidural combined with smal dose of intravenous anesthesia in total knee arthroplasty in elderly hypertensive patients. METHODS:A total of 64 elderly hypertensive patients with arthroplasty in the Third Hospital of Hebei Medical University from December 2013 to December 2014 were selected and were divided into control group (32 cases) and observation group (32 cases). They were given total intravenous anesthesia and epidural block combined with smal dose of intravenous anesthesia. Systolic blood pressure, diastolic blood pressure, heart rate, blood oxygen saturation and changes in respiratory rate were detected before anesthesia, after anesthesia induction, 10 minutes after anesthesia, 10 minutes after use of bone cement, and at the end of arthroplasty in both groups. The usage of vasoactive drugs (including ephedrine and dopamine) during arthroplasty and adverse events after arthroplasty were recorded. RESULTS AND CONCLUSION:Compared with pre-anesthesia, systolic blood pressure and diastolic blood pressure were significantly reduced and blood oxygen saturation was increased at 10 minutes after anesthesia and 10 minutes after the application of bone cement in both groups (P<0.05). In the end of arthroplasty, systolic blood pressure, diastolic blood pressure and respiratory rate were significantly higher in the control group than in the observation group (P<0.05). A total of 3 cases in the observation group and 15 cases in the control group used vasoactive drugs (including ephedrine and dopamine), and there was a significant difference in its usage (P<0.05). Moreover, five patients in the control group experienced respiratory insufficiency, which was apparently improved after given the short-term ventilator support. These results confirm that compared with the total intravenous anesthesia, epidural block combined with smal dose of intravenous anesthesia showed a high safety during total knee arthroplasty in elderly hypertensive patients.