Effects of propofol combined with etomidate on pulmonary complications and quality of recovery after laparoscopic abdominal surgery in elderly patients
AIM To observe the effects of propofol combined with etomidate on pulmonary complications and quality of recovery after laparoscopic abdominal surgery in elderly patients.METHODS Eighty patients undergoing elective laparoscopic abdominal surgery,aged 60 to 85 years,ASA physical status Ⅱ or Ⅲ,were randomly allocated into two groups with 40 cases in each group.Both groups received midazolam 0.02-0.05 mg·kg-1+sufentanil 0.5 μg·kg-1+rocuronium 0.6 mg·kg-1 for anesthesia induction,propofol 2.5 mg·kg-1 was added to the control group and etomidate 0.2 mg·kg-1 combined with propofol 1 mg·kg-1 were added to the experimental group.The control group was given propofol 6-8 mg·kg-1·h-1 and remifentanil 4-6 μg·kg-1·h-1 intravenous pump for maintenance,while the experimental group was given propofol 4-6 mg·kg-1·h-1 combined with etomidate 0.2-0.4 mg·kg-1·h-1 and remifentanil 4-6 μg·kg-1·h-1 for maintenance.Patients'heart rate(HR)and mean arterial pressure(MAP)were observed and recorded,serum interleukin(IL)-6 and tumor necrosis factor(TNF)-α concentrations were measured,QoR-15 scale score and the incidence of postoperative pulmonary complications(PPCs)were assessed.RESULTS MAP and HR were significantly higher in the experimental group than those in the control group at 30 minutes of anesthesia induction and at the end of surgery(P＜0.05).The serum concentrations of IL-6 and TNF-α in the experimental group were significantly lower than those in the control group at the end of surgery and 24 hours after surgery(P＜0.05).There was no significant difference in recovery time and extubation time between the two groups(P＞0.05),and there was no significant difference in QoR-15 scale score 1 day before surgery(P＞0.05).The QoR-15 scale score in the experimental group was significantly higher than that in the control group 1 day after operation.The incidence of PPCs was 12％(5/40)in the experimental group,which was significantly lower than that 38％(15/40)in the control group(P＜0.05).CONCLUSION Combination of propofol and etomidate for anesthesia can alleviate the perioperative inflammatory response,reduce the incidence of PPCs and improve the quality of postoperative recovery in elderly patients undergoing laparoscopic abdominal surgery.
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