title: Awakening from anesthesia using propofol or sevoflurane with epidural block in radical surgery for senile gastric cancer.
abstract: OBJECTIVE
  To study the awakening of the elderly patients from propofol intravenous general anesthesia or sevoflurane inhalation general anesthesia combined with epidural block after radical gastric cancer surgery.
  
  
  METHODS
  Eighty cases receiving selective radical surgery for gastric cancer were included. They were aged 65-78 years and classified as ASA grade I-II. Using a random number table, the cases were divided into 4 groups (n = 20): propofol intravenous general anesthesia (P group), sevoflurane inhalation general anesthesia (S group), propofol intravenous general anesthesia combined with epidural block (PE group), and sevoflurane inhalation general anesthesia combined with epidural block (SE group). For P and PE group, target controlled infusion of propofol was performed; for S and SE group, sevoflurane was inhaled to induce and maintain general anesthesia; for PE and SE group, before general anesthesia induction, epidural puncture and catheterization at T7-8 was performed. After surgery, perform patient controlled intravenous analgesia (PCIA) or patient controlled epidural analgesia (PCEA), and maintain VAS ≤ 3. The recorded indicators were as follows: time to recovery of spontaneous respiration, time to awakening, time of endotracheal tube removal, time to orientation, time to achieve modified Aldrete scores ≥ 9, modified OAA/S and Aldrete scores upon endotracheal tube removal (T1), 5 min after removal (T2), 15 min after removal (T3) and 30 min after removal (T4), dose of intraoperative remifentanil, intraoperative hypotension, and emergence agitation.
  
  
  RESULTS
  Time to awakening, time of endotracheal tube removal, time to orientation, and time to achieve modified Aldrete scores ≥ 9 in PE and SE group were obviously shortened compared with P and S group (P < 0.05); modified OAA/S and Aldrete scores at T1 and T2 in PE and SE group were significantly higher than those in P and S group (P < 0.05), and the scores of SE group at T1 were much higher compared to PE group (P < 0.05). Dose of intraoperative remifentanil in PE and SE group was significantly lower than that in P and S group.
  
  
  CONCLUSIONS
  Compared to propofol intravenous general anesthesia or sevoflurane inhalation general anesthesia, propofol or sevoflurane general anesthesia combined with epidural block was more conducive to increasing the awakening quality of the senile patients from anesthesia after radical gastric cancer surgery. Moreover, sevofluorane inhalation general anesthesia combined with epidural block achieved a more stable hemodynamics and a shortened time to awakening.
authors.affiliation: Department of Anesthesiology, The Fourth Affiliated Hospital, Anhui Medical University Hefei 230022, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology, The Fourth Affiliated Hospital, Anhui Medical University Hefei 230022, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Anesthesiology, The Fourth Affiliated Hospital, Anhui Medical University Hefei 230022, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, The Fourth Affiliated Hospital, Anhui Medical University Hefei 230022, China.
authors.forename: Gao
authors.initials: G
authors.lastname: Cheng
authors.affiliation: Department of Anesthesiology, The Fourth Affiliated Hospital, Anhui Medical University Hefei 230022, China.
authors.forename: Wei-Wei
authors.initials: WW
authors.lastname: Wu
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital, Anhui Medical University Hefei 230032, China.
authors.forename: Yuan-Hai
authors.initials: YH
authors.lastname: Li
keywords: Propofol; awakening; epidural block; radical surgery for senile gastric cancer; sevoflurane