title: Effects of combined epidural analgesia with total intravenous anesthesia on risky patients underwent major abdominal surgery.
abstract: OBJECTIVE
  The aim of this study is to investigate the effects of combined epidural analgesia with total intravenous anaesthesia and only total intravenous anaesthesia on the different clinical parameters.
  
  
  METHODS
  Sixty high risk patients undergoing a major abdominal surgical procedure were included in this prospective, double blind, randomized study. Induction of anaesthesia was performed with IV remifentanil 0.5µg/kg and propofol titrated to achieve bispectral index score between 40 and 50. after intubation; in Group E, 0.1% bupivacaine and 2 µg/mL fentanyl were administered by an infusion rate at 0.15 ml/kg/h via the epidural catheter and Group C received epidural normal saline as same infusion rate.
  
  
  RESULTS
  In group E, intraoperative MAP values were significantly lower than those in group C (p<0.05). Time of extubation, time of eye opening with audible warning and time of verbal response was significantly lower in group E than those in group C. Total anaesthetic drug consumption was significantly higher in group C than those in group E (p<0.05).
  
  
  CONCLUSIONS
  Based on lower requirements for propofol and remifentanil as well as the favourable effects on clinical parameters; we conclude that bispectral index score guided combined epidural with total intravenous anaesthesia is superior to solely total intravenous anaesthesia in this type of surgery.
authors: Department of Anaesthesiology and Reanimation, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.
authors: Tülin
authors: T
authors: Akarsu Ayazoğlu
authors: Department of Anaesthesiology and Reanimation, Kartal Kosuyolu High Speciality Training and Research Hospital, Istanbul, Turkey.
authors: Aynur
authors: A
authors: Özensoy
authors: Department of Anaesthesiology and Reanimation, Kartal Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey.
authors: Fatih Doğu
authors: FD
authors: Geyik
authors: Department of Anaesthesiology and Reanimation, Bezmi Alem Vakif University Faculty of Medicine Hospital, Istanbul, Turkey.
authors: Muhittin
authors: M
authors: Çalım
authors: Department of General Surgery, Sevket Yilmaz Training and Research Hospital, Bursa, Turkey.
authors: Uğur
authors: U
authors: Duman
authors: Department of Anaesthesiology and Reanimation, Rize State Hospital, Rize, Turkey.
authors: Mehmet Akif
authors: MA
authors: Candan
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous; D062186:Arterial Pressure; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate; D006801:Humans; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D010880:Piperidines; D015742:Propofol; D011446:Prospective Studies; D000077208:Remifentanil
chemical_list: D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D010880:Piperidines; D008012:Lidocaine; D000077208:Remifentanil; D015742:Propofol