RESUMO
Objective:To evaluate the effect of general anesthesia combined with epidural block on postoperative sleep in the frail elderly patients undergoing gastrointestinal tumor surgery.Methods:Ninety frail patients of either sex, aged 65-80 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiology physical status Ⅱ-Ⅲ, scheduled for elective open gastrointestinal tumor surgery (FRAIL score >2), were divided into 2 groups ( n=45 each) using a random number table method: general anesthesia group (GA group) and general anesthesia combined with epidural block group (GE group). Combined intravenous-inhalational anesthesia was carried out in group GA.Epidural block was performed before induction of anesthesia, and the method of general anesthesia was the same as that described in group GA, and the consumption of propofol and remifentanil was adjusted according to the BIS value, sweat and tears, heart rate and blood pressure during operation in group GE.Postoperative intravenous analgesia was performed to maintain VAS score ≤3.Wearable devices were used to monitor sleep parameters at 1 day before surgery and 1, 3 and 7 days after surgery.Sleep quality was assessed using Pittsburgh Sleep Quality Index and Quality of Recovery-15 questionnaire at 1 day before surgery and 1, 3, 7 and 30 days after surgery.The intraoperative consumption of propofol, sufentanil and remifentanil were recorded.The requirement for postoperative rescue analgesia and total pressing times of patient-controlled analgesia (PCA) within 48 h after surgery were recorded.Serum C-reactive protein concentrations were determined by immunoturbidimetry at 1 day before surgery and 1 day after surgery, and the adverse reactions at 7 days after surgery were recorded. Results:Compared with group GA, the consumption of remifentanil was significantly reduced, the total sleep score, deep sleep ratio, rapid eye movement ratio and Quality of Recovery-15 score were increased, the Pittsburgh Sleep Quality Index was decreased, and the incidence of postoperative nausea and vomiting was decreased on 1st and 3rd days after operation ( P<0.05), and no significant change was found in the serum C-reactive protein concentration and postoperative requirement for rescue analgesia, and total pressing times of PCA in group GE ( P>0.05). Conclusions:General anesthesia combined with epidural block can improve short-term sleep quality and recovery quality after gastrointestinal tumor surgery in elderly frail patients.
RESUMO
Objective:To evaluate the effect of general anesthesia guided by bispectral index (BIS) on postoperative sleep quality in elderly patients undergoing laparoscopic gastrointestinal tumor surgery.Methods:A total of 90 patients, aged 65-80 yr, with body mass index of 18-25 kg/m 2, of American Society of Anesthesiology physical status Ⅰ-Ⅲ, without preoperative sleep disorders, undergoing elective laparoscopic gastrointestinal tumor surgery, were divided into 3 groups ( n=30 each) using a random number table method: control group (group C) and different BIS value groups (group B1 and group B2). Combined intravenous-inhalational anesthesia was used.The BIS value in group B1 was maintained at 40-49, and the BIS value in group B2 was maintained at 50-60.The fluctuation range of heart rate and blood pressure was not more than 20% of the baseline, and vasoactive agents were administered when necessary in group C. Patient-controlled intravenous analgesia was performed with sufentanil, dezocine and palonosetron after surgery.When visual analog scale score>3, acetaminophen oxycodone tablets 5 mg was taken orally or flurbiprofen 50 mg was intravenously injected as rescue analgesic.At 1 day before surgery and 1, 3, 7 and 30 days after surgery, sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), postoperative sleep disorders were defined as PSQI scone≥6, and the development of postoperative sleep disorders was recorded.During the nighttime at 1 day before surgery and during the nighttime at 1, 2 and 3 days after surgery, sleep was monitored using body motion monitor (Honor Band 5). The intraoperative consumption of propofol and remifentanil and requirement for rescue analgesia at 48 h after surgery were recorded.The Quality of Recovery-15 (QoR-15) scores were measured at 1, 3 and 7 days after surgery.At 1 day before surgery and at 1 day after surgery, serum C-reactive protein concentrations were determined by immunoturbidimetry. Results:Compared with group C, PSQI scores were significantly decreased at 1 and 3 days after surgery, the incidence of sleep disorders was decreased at 3 days after surgery, sleep time, sleep score and proportion of rapid eye movement sleep time during the nighttime at 1 and 2 days after surgery were increased, intraoperative consumption of propofol was decreased, QoR-15 score at each time point after surgery was increased, and postoperative length of hospital stay was prolonged in group B2 and group B2 ( P<0.05). Compared with group B1, PSQI scores were significantly decreased at 1 and 3 days after surgery, sleep time, sleep score and proportion of rapid eye movement sleep time during the nighttime at 1 and 2 days after surgery were increased, intraoperative consumption of propofol was decreased, QoR-15 score at each time point after surgery was increased ( P<0.05), and no significant change was found in the incidence of sleep disorders at each time point in group B2 ( P>0.05). There was no significant difference in CPR concentrations and the number of rescue analgesia after surgery at each time point among the 3 groups ( P>0.05). Conclusion:General anesthesia guided by BIS can improve postoperative sleep quality in elderly patients undergoing laparoscopic gastrointestinal tumor surgery, and BIS value maintained at 50-60 provides better effect on postoperative sleep quality and is more helpful for postoperative recovery.
