Anesthesia Clinical Trial
Official title:
To Investigate Difference of Plasma Orexin A Levels Between Elderly and Youth Patients at Emergence From Sevoflurane-fentanyl Anesthesia Undergoing Elective Lumbar Surgery
The current study is designed to investigate the difference of plasma orexin A levels between elderly and young patients at emergence from sevoflurane-fentanyl anesthesia who will undergo elective lumbar surgery.
BACKGROUND:A specific group of neurons in the brain produces hypocretin, also called orexin,
a peptide which has been established as an important regulator of anesthesia and emergence
in the latest few years. In the animal experiment,we found that the level of orexin A in
aged rats was higher when compared with that of the young ones. Whereas the numbers of both
the orexin receptor 1 and 2 in aged rats decreased. We wonder if there is a similar
phenomenon in human beings which might account for the difference between the intervals of
elderly and young patients recovering from anesthesia. This study aims to investigate
difference of plasma orexin A levels between elderly patients and young at emergence from
sevoflurane-fentanyl anesthesia.
DESIGNING:Forty patients with ASA physical status I or II scheduled for elective lumbar
surgery under general anesthesia (lasting for 2h to 4h)were enrolled. Anesthesia was induced
with propofol 1-1.5mg/kg and fentanyl 2-3μg/kg. Following muscle relaxation with iv
rocuronium bromide 1mg/kg endotracheal intubation was performed. Anesthesia was maintained
with sevoflurane(inhalational concentration: 0.8-1.5 MAC) fentanyl (total 6μg/kg) and target
controlled infusion remifentanil (targeted concentration:2-7ng/ml ) along with an oxygen/air
mixture (FiO2 = 0.5). Muscle relaxation was maintained with intermittent rocuronium.
Inhalational concentration of sevoflurane and injected target concentration were titrated to
maintain the bispectral index (BIS) between 45 and 65 during anesthesia. The end-tidal
carbon dioxide level was maintained between 30 and 40mmHg by controlled mechanical
ventilation. When the surgery was complicated we adjust the concentration sevoflurane to
0.8MAC of the patient and targeted concentration of remifentanil to 2ng/ml and then stop all
anesthetics . Record time from stopping anesthetics to emergence. Arterial blood (2ml) was
collected at the following time, such as before and 1h after induction of anesthesia, at
emergence (1min after tracheal extubation) and half an hour after tracheal extubation. This
was centrifuged at 3000 rpm for 15min at −4 ◦C in order to separate plasma then stored at
−80 ◦C until assay for orexin A concentrations.
EXPECTED RESULTS:The plasma orexin A of group elderly will be higher with the emergence time
longer than youth patients.
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