Background: There are two components to the anesthetic state, first component is the loss of consciousness and recall, the second component is obtundation of reflex responses to a noxious stimulus, which occurs below the level of cortex. The problem of unexpected awareness has concerned patients and anesthesiologists since the administration of general anesthesia was first described, the incorporation of paralytic agents into the administration of general anesthetics was associated with an epidemic of cases of awareness.
Aim of the study:To determine the effect of epidural bupivacaine on the requirement doses of propofol, fentanyl, and cisatrcurium and on stress response during major abdominal surgery. Patients and methods: This is a randomized, prospective clinical trial, performed in Assiut university hospital in general surgery theatre and department between April 2010 and October 2014. The protocol of the study was approved by our local ethical committee and informed written consent was obtained from all patients. The study included 80 patients of both genders scheduled for major abdominal surgery, age ranged between 18 and 75 years, with ASA physical status between I and III. Patients were divided equally and randomly into two groups to receive general anesthesia or combined general and epidural anesthesia. The induction and maintenance doses of propofol, fentanyl, and muscle relaxants were calculated in addition to hemodynamic changes, fasting blood sugar, serum cortisol, TSH and interleukin-6 level.Results: Patients received combined general and thoracic epidural anesthesia showed lower requirements of general anesthetics and muscle relaxants, lower intra and postoperative FBS and serum cortisol levelinterleukin-6 level and higher TSH level.
Conclusion:Combined general and thoracic epidural block decrease the need of general anesthesia and muscle relaxants, decrease stress response more than general anesthesia alone during major abdominal surgery.