Sparing Effects of Sevoflurane Requirement during Combined Epidural-General Anesthesia Comparing to General Anesthesia for Laparoscopic Distal Gastrectomy

Abstract

Background: Combined thoracic epidural-general anesthesia have many advantages, which are including early recovery, postoperative analgesia and less requirement of inhalation anesthetic. The aim of this study was to compare the requirements of sevoflurane during combined epidural-general anesthesia with those during only general anesthesia for laparoscopic distal gastrectomy. Methods: Forty patients undergoing laparoscopic distal gastectomy under general anesthesia were allocated randomly to two groups receiving infusion of epidural 0.375% ropivacaine mixed with 2g/ml sufentanil at 5 ml/hr following 8 ml bolus (group R), or epidural normal saline (group C) as the same method. All the patients were permitted to be infused to epidural 0.2% ropivacaine mixed with 1g/ml sufentanil at 5 ml/hr 30 minutes before end of surgery for postoperative analgesia. Anesthetic depth was maintained within 15% mean arterial blood pressure (MAP) of basal values. We recorded the end-tidal sevoflurane concentration (ETsev), mean arterial pressure (MAP) and heart rate (HR) at the critical time during the surgery (intubation, 3 minuets after intubation, skin incision, pneumoperitoneum, 3 minuets after pneumoperitoneum, end point of pneumoperitoneum, abdominal wall suture, extubation) and hourly consumptional volume of sevoflurane. Results: Both groups were similar in demographic data, surgery anesthetic time and postoperative pain score. But the stay time in post anesthetic care unit was significantly shorter in R group. ETsev were lower in group R than in group C during the study period. Actually approximately half volume of sevoflurane was consumed in group R comparing to group C. Conclusions: For laparoscopic distal gastrectomy, smaller amount of sevoflurane was used during combined thoracic epidural-general anesthesia than during general anesthesia.