Central Hemodynamic Features in Elderly Patients During General Anesthesia with Sevoflurane
Objective: to reduce the number of perioperative cardiovascular events in elderly patients during traditional cholecystectomy, by using anesthesia based on sevoflurane (SF) and fentanyl (FL). Subjects and methods. Forty5eight patients aged 60 to 75 years, who were divided into 2 groups, operated on by a classical surgical technique for chronic calculous cholecystitis in the presence of concomitant coronary heart disease and essential hypertension, and had grade 3 surgical risk according to the classification of the Moscow Research Society of Anesthesiologists and Reanimatologists, were examined. Premedicaton was routine. The induction of anesthesia was as follows: intravenous propofol (PF) (1.8±0.2 mg/kg) and FL (2.2±0.4 mg/kg) in Groups 1 and 2. General anesthesia (GA) was maintained by SF (1.1±0.2 MAC) and FL (2.4±0.4 μg/kg/hr) in Group 1 (n=25) and by PF (2.0-4.0 mg/kg/hr) and FL (3.5±0.7 μg/kg/hr) in Group 2 (n=23). In both groups, mechanical ventilation was as follows: N2O:O2 = 2:1; air flow, 6 l/min. Myoplegia was rocuronium bromide (RB) (0.075-0.1 mg/kg) in Group 1 and RB (0.15 mg/kg) in Group 2. Hemodynamics was studied during 5 stages of surgery. Results. Central hemodynamics (CH) was rather stable in patients after GA with SF. Significant CH changes were noted only during the traumatic stage of surgery, which were less pronounced than those in patients following GA with PF. CH parameters returned gradually to the baseline values at the end of surgery and virtually to the background values after tracheal extubation. The patients under GA with PF showed significant CH changes at all stages of the study. Conclusion. Analysis of the systemic hemodynamic changes induced by the use of SF and PF suggests that GA with SF in elderly patients is more preferable than that in those with PF.