American journal of translational research · 2025
Comparison of combined intravenous-inhalation anesthesia and total intravenous anesthesia in perioperative stress and outcomes of elderly patients undergoing hepatectomy.
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Zhang Chen, Liu Juan
Аннотация
OBJECTIVE: To compare the effects of combined intravenous-inhalation anesthesia (CIVIA) and total intravenous anesthesia (TIVA) in elderly patients undergoing hepatectomy, and to evaluate their impact on perioperative stress response and postoperative outcomes.
METHODS: A retrospective analysis was performed on 208 elderly patients who had undergone hepatectomy. The patients were divided into the CIVIA group (n=106) and the TIVA group (n=102) according to their anesthesia protocol. The CIVIA group received sevoflurane inhalation combined with propofol intravenous-inhalation anesthesia, while the TIVA group received only propofol and remifentanil intravenous infusion anesthesia. Baseline clinical indicators were compared between the groups. Stress response markers, hemodynamic parameters, and inflammatory indices were assessed at four timepoints: before anesthesia induction, immediately after surgery, and 12 h and 24 h postoperatively. In addition, the Observer's Assessment of Alertness/Sedation (OAA/S) score, Aldrete score, Mini-Mental State Examination (MMSE) score, perioperative pain score, Ramsay score, and the incidence of complications were compared between the two groups.
RESULTS: Intraoperative blood loss (OR=0.868, 95% CI=0.818-0.921), anesthesia maintenance time (OR=0.695, 95% CI=0.592-815), and intraoperative complications (OR=0.0.159, 95% CI=0.030-0.853) were significantly associated with anesthesia techniques (all P < 0.05). The CIVIA group showed significantly shorter postoperative recovery, time to regain consciousness, and extubation time compared with the TIVA group (P < 0.05). Moreover, the CIVIA group exhibited more favorable results in stress response, hemodynamic stability, inflammatory indices, OAA/S score, Aldrete score, MMSE score, perioperative pain score, and postoperative complication rates at the immediate, 12 h, and 24 h postoperative assessments.
CONCLUSION: CIVIA shows significant clinical advantages in elderly patients with liver disease undergoing hepatectomy. This regimen provides effective anesthetic depth, maintains intraoperative hemodynamic stability, attenuates perioperative stress response, and reduces the risk of postoperative complications, making it a preferred anesthesia strategy in this population.
METHODS: A retrospective analysis was performed on 208 elderly patients who had undergone hepatectomy. The patients were divided into the CIVIA group (n=106) and the TIVA group (n=102) according to their anesthesia protocol. The CIVIA group received sevoflurane inhalation combined with propofol intravenous-inhalation anesthesia, while the TIVA group received only propofol and remifentanil intravenous infusion anesthesia. Baseline clinical indicators were compared between the groups. Stress response markers, hemodynamic parameters, and inflammatory indices were assessed at four timepoints: before anesthesia induction, immediately after surgery, and 12 h and 24 h postoperatively. In addition, the Observer's Assessment of Alertness/Sedation (OAA/S) score, Aldrete score, Mini-Mental State Examination (MMSE) score, perioperative pain score, Ramsay score, and the incidence of complications were compared between the two groups.
RESULTS: Intraoperative blood loss (OR=0.868, 95% CI=0.818-0.921), anesthesia maintenance time (OR=0.695, 95% CI=0.592-815), and intraoperative complications (OR=0.0.159, 95% CI=0.030-0.853) were significantly associated with anesthesia techniques (all P < 0.05). The CIVIA group showed significantly shorter postoperative recovery, time to regain consciousness, and extubation time compared with the TIVA group (P < 0.05). Moreover, the CIVIA group exhibited more favorable results in stress response, hemodynamic stability, inflammatory indices, OAA/S score, Aldrete score, MMSE score, perioperative pain score, and postoperative complication rates at the immediate, 12 h, and 24 h postoperative assessments.
CONCLUSION: CIVIA shows significant clinical advantages in elderly patients with liver disease undergoing hepatectomy. This regimen provides effective anesthetic depth, maintains intraoperative hemodynamic stability, attenuates perioperative stress response, and reduces the risk of postoperative complications, making it a preferred anesthesia strategy in this population.