General Anesthesia and General Anesthesia Combined With Thoracic Epidural Anesthesia

Study Overview
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Brief Summary
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It was aimed to investigate whether epidural anesthesia added to general anesthesia has an effect on neuromuscular block.

Detailed Description
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The study was carried out with patients who were evaluated preoperatively in the Department of Anesthesiology and Reanimation, Department of Anesthesiology, Faculty of Medicine, Yuzuncu Yıl University. Sixty ASA I-II group patients, aged between 18-65 and scheduled for gastric ca operation, were included in the study. Severe heart, lung, liver disease, kidney failure, bleeding diathesis, fever, infection, allergy to drugs to be used, those who refused to participate in the study, patients with hypothermic and acid-base disorders, electrolyte disorders such as hypokalemia, hypocalcemia, antibiotics, anticonvulsants, Those taking antiarrhythmic and cholinesterase inhibitors were excluded from the study. The cases were divided into 2 groups by the envelope method, 30 people will be included in the general anesthesia group (GA), and 30 people will be included in the general anesthesia and thoracic epidural anesthesia group (GAE). After the patients who did not receive premedication were taken to the operating room, standard monitoring was provided with ECG, non-invasive arterial pressure, peripheral oxygen saturation. Peripheral vein cannulation was performed with a 20 gauge i.v. catheter, and a 4 mL/kg 0.9% NaCl infusion was started. In Group GAE, after preoperative asepsis was achieved, cutaneous-subcutaneous local anesthetic was infiltrated through the T7-9 space. The epidural space was determined by the loss of resistance method with a 16 gauge Tuohy epidural needle, and an 18 gauge epidural catheter was placed in the epidural space at a 4 cm angle in the cranial direction. The location of the catheter was confirmed by applying a test dose of 3 mL 2% lidocaine containing 5μ/ml adrenaline. After 5 minutes, 5 ml of 0.125% bupivacaine was given and the patient was placed in the supine position immediately afterwards. Electrodes were placed for TOF monitoring after thoracic epidural catheterization in the GAE group. Anesthesia induction was applied to all patients with 1mg/kg lidocaine, 1μcg/kg fentanyl, 2mg/kg propofol, 0.6mg/kg rocuronium. When the Train of four (TOF) value was 0, patients were intubated with an endotracheal tube (7-7.5 endotracheal tube (ETT) for women, 8-8.5 ETT for men). In maintenance, desflurane at 8% concentration was applied in a mixture of 50% O2 + 50% air. The time to reach 25% of the TOF value for both groups was noted. 0.1mg/kg rocuronium was added to patients who reached 0.25. The number of additional muscle relaxant requirements was recorded. In the GAE group, 5 ml of epidural drug was given every hour. In the GA group, 0.05mg/kg morphine was given 30 minutes before the end of the operation. Considering the time it took for the TOF value to reach 70%, the inhaler anesthetics were terminated and the patients with a TOF value of 90% were extubated.

Official Title
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The Effect of General Anesthesia and General Anesthesia Combined With Thoracic Epidural Anesthesia on Neuromuscular Block

Conditions
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Thoracal Epidural Block

Intervention / Treatment
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* Procedure: Neuromuscular blocker usage


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA I-II group 60 patients 18-65 who were scheduled for gastric ca operation were included in the study. Exclusion Criteria: severe heart, lung, liver disease, kidney failure, bleeding diathesis, fever, infection, allergy to drugs to be used, those who refused to participate in the study, patients with hypothermic and acid-base disorders, electrolyte disorders antibiotics, anticonvulsants, Those taking antiarrhythmic, cholinesterase inhibitors will be excluded from the study.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Screening
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Randomized prospective, controlled study
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Sham Comparator: Group general anesthesia (GA)<br>Anesthesia induction was applied to all patients with 1mg/kg lidocaine, 1μcg/kg fentanyl, 2mg/kg propofol, 0.6mg/kg rocuronium. When the TOF value was 0, the patients were intubated with an endotracheal tube. In the maintenance, desflurane at 8% concentration was used in a mixture of 50% O2 + 50% air. The time to reach 25% of the TOF value was noted in both groups. 0.1mg/kg rocuronium will be added to patients who reach 0.25.It was planned to administer 0.05mg/kg morphine 30 minutes before the end of the operation to the GA group. | Procedure: Neuromuscular blocker usage<br>* The patients were followed up, the total amount of muscle relaxant used was determined, intraoperative effects and postoperative analgesic usage<br>* Other names: Visual analog scale;|
| Experimental: Group General anesthesia and Thoracal epidural (GAE)<br>Electrodes were placed for TOF monitoring after thoracic epidural catheterization in the GAE group. Anesthesia induction was applied to all patients with 1mg/kg lidocaine, 1μcg/kg fentanyl, 2mg/kg propofol, 0.6mg/kg rocuronium. When the TOF value was 0, the patients were intubated with an endotracheal tube. In the maintenance, desflurane at 8% concentration was used in a mixture of 50% O2 + 50% air. The time to reach 25% of the TOF value was noted in both groups. 0.1mg/kg rocuronium will be added to patients who reach 0.25.The number of additional muscle relaxant requirements made will be recorded. In the GAE group, 5 ml of epidural medication will be given per hour. When the TOF value reached 70%, inhaler anesthetics were discontinued and the patients with a TOF value of 90% were extubated. | Procedure: Neuromuscular blocker usage<br>* The patients were followed up, the total amount of muscle relaxant used was determined, intraoperative effects and postoperative analgesic usage<br>* Other names: Visual analog scale;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neuromuscular agent | Total neuromuscular consumption | 30 minute |