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Background:Artificial femoral head replacement is one of the most effective methods for treatment of severe diseases of femoral joint in the elderly. The ideal anesthetic effect is one of the key elements for the success of the operation because it brings fast recovery. However, the multiple comorbidities of the elder patients make them too weak to tolerate the hemodynamic changes after anesthesia. Objective:To compare the post-anesthetic hemodynamic changes between combined lumbar plexus and sciatic nerve block(CLPSB) and combined spinal and epidural anesthesia(CSEA) in elderly patients undergoing unilateral artificial femoral head replacement.Methods:We reviewed records of the patients who aged over 60 years old (age 62-103 years) and received unilateral artificial femoral head replacement. 477 patients were included and divided into CLPSB group (n=90) and CSEA group (n=387). The primary outcome was comparison of the hemodynamic changes after anesthesia, including the SBP, diastolic blood pressure DBP, MAP and (HR). The second outcome was the comparison of the vasopressor used during the surgery.Results:We established three models to compare the two anesthesia methods on hemodynamic changes.All three models exhibit that changes of MAP (∆MAP) after CSEA were higher than that after CLPSB(β= 6.88, 95% CI: 4.33 - 9.42, P < 0.0001), with significant difference, which indicated that CSEA causes higher fluctuation of MAP. Concurrently, the use of vasopressors increased by 137% (OR=2.37, 95%CI: 1.24-4.53, P=0.0091) in the CSEA group, which is statistically significant. However, the changes of HR (∆HR) between the CLPSB and CSEA was not significant(β= 0.50, 95% CI: 1.62 - 2.62, P = 0.6427). Conclusions:Both CLPSB and CSEA are ideal anesthesia methods for patients receiving femoral head eplacement, though CLPSB is more suitable for elderly patients with advanced hemodynamic stability.

To investigate the effect of pre-injection Shenfu injection on the hemodynamics of radical resection of colorectal cancer in elderly patients with hypertension. The candidates were randomly divided into control group (receiving pre-injection of sodium chloride injection) and research group (receiveing pre-injection of Shenfu injection) before anesthesia induction. The perioperative hemodynamic changes and use of vasoactive drugs were compared. Mean arterial pressure (MAP), diastolic blood pressure (DBP) and systolic blood pressure (SBP) values in the research group were lower than those in the control group at the time of tracheal tube extraction (P < 0.05). The use rate of antihypertensive drugs in the research group was lower than those in the control group (P < 0.05). Pre-injection of Shenfu in elderly hypertensive patients had no influence on anesthesia effect and it can reduce the volatility of hemodynamic parameters, decrease the use of vasoactive drugs.

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