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Li Y, Sun L, Zhou Q, Lee AJ, Wang L, Zhang R, Wang S. Effects of opioid drugs on immune function in cancer patients. Biomed Pharmacother 2024; 175:116665. [PMID: 38701564 DOI: 10.1016/j.biopha.2024.116665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024] Open
Abstract
Opioid receptor agonists are often used when cancer patients undergo surgery or analgesic treatment. As analgesics in clinical care, opioids can provide intraoperative or to chronic cancer pain relief. Immune function plays an important role in anti-cancer therapy, with cellular immunity, comprised principally of T-lymphocytes and natural killer cells, representing the primary anti-cancer immune response. However, it remains unclear whether immune function is further affected with the use of opioids in already immunocompromised cancer patients. This article provides a review of the effects of commonly used clinical opioids, including morphine, oxycodone, fentanyl and tramadol, on immune function in cancer patients. It provides a summary of current evidence regarding the immunomodulatory effects of opioids in the cancer setting and mechanisms underlying these interactions.
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Affiliation(s)
- Yunqi Li
- School of Anesthesiology, Weifang Medical University, Weifang 261053, China
| | - Lina Sun
- School of Anesthesiology, Weifang Medical University, Weifang 261053, China.
| | - Qinglian Zhou
- School of Anesthesiology, Weifang Medical University, Weifang 261053, China
| | - An Jie Lee
- Biological Sciences, University of California San Diego, La Jolla, CA 92093, United States
| | - Lingyan Wang
- School of Anesthesiology, Weifang Medical University, Weifang 261053, China
| | - Rui Zhang
- School of Anesthesiology, Weifang Medical University, Weifang 261053, China.
| | - Shoushi Wang
- Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao 266042, China.
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Ivascu R, Torsin LI, Hostiuc L, Nitipir C, Corneci D, Dutu M. The Surgical Stress Response and Anesthesia: A Narrative Review. J Clin Med 2024; 13:3017. [PMID: 38792558 PMCID: PMC11121777 DOI: 10.3390/jcm13103017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/28/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
The human physiological response "to stress" includes all metabolic and hormonal changes produced by a traumatic event at the micro or macro cellular levels. The main goal of the body's first response to trauma is to keep physiological homeostasis. The perioperative non-specific adaptation response can sometimes be detrimental and can produce systemic inflammatory response syndrome (SIRS), characterized by hypermetabolism and hyper catabolism. We performed a narrative review consisting of a description of the surgical stress response's categories of changes (neurohormonal and immunological response) followed by reviewing methods found in published studies to modulate the surgical stress response perioperatively. We described various preoperative measures cited in the literature as lowering the burden of surgical trauma. This article revises the anesthetic drugs and techniques that have an impact on the surgical stress response and proven immune-modulatory effects. We also tried to name present knowledge gaps requiring future research. Our review concludes that proper preoperative measures, adequate general anesthetics, multimodal analgesia, early postoperative mobilization, and early enteral nutrition can decrease the stress response to surgery and ease patient recovery. Anesthetics and analgesics used during the perioperative period may modulate the innate and adaptive immune system and inflammatory system, with a consecutive impact on cancer recurrence and long-term outcomes.
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Affiliation(s)
- Robert Ivascu
- Department of Anesthesiology and Intensive Care, Carol Davila University of Medicine and Pharmacy, 0200021 Bucharest, Romania; (R.I.); (D.C.)
- Department of Anesthesiology and Intensive Care, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania; (L.I.T.); (L.H.)
| | - Ligia I. Torsin
- Department of Anesthesiology and Intensive Care, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania; (L.I.T.); (L.H.)
| | - Laura Hostiuc
- Department of Anesthesiology and Intensive Care, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania; (L.I.T.); (L.H.)
| | - Cornelia Nitipir
- Department of Oncology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Oncology, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Dan Corneci
- Department of Anesthesiology and Intensive Care, Carol Davila University of Medicine and Pharmacy, 0200021 Bucharest, Romania; (R.I.); (D.C.)
- Department of Anesthesiology and Intensive Care, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania; (L.I.T.); (L.H.)
| | - Madalina Dutu
- Department of Anesthesiology and Intensive Care, Carol Davila University of Medicine and Pharmacy, 0200021 Bucharest, Romania; (R.I.); (D.C.)
- Department of Anesthesiology and Intensive Care, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania; (L.I.T.); (L.H.)
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Romi R, Hoda W, Kumar S, Bharati B, Toppo S, Singh D, Oraon P, Kumari R, Lakra A, Priye S. Comparative Study of Levobupivacaine Versus Levobupivacaine With Dexmedetomidine as an Adjuvant in Transversus Abdominis Block for Postoperative Pain Relief in Abdominal Hysterectomy Patients: A Randomized, Double-Blind Study. Cureus 2024; 16:e59523. [PMID: 38826898 PMCID: PMC11144035 DOI: 10.7759/cureus.59523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
Background Adjuvants have been discovered to prolong the analgesic impact of local anesthetics (LA), while the transversus abdominis plane (TAP) block offers sufficient postoperative pain relief after various abdominal procedures. Nevertheless, the impact of the given LA will determine the duration of the TAP block. Thus, in this investigation, we aimed to estimate the analgesic impact of combining dexmedetomidine (DEX) with levobupivacaine in the TAP block for patients having an infraumbilical incision for an abdominal hysterectomy while under spinal anesthetic. Aim This study aimed to determine the analgesic effect of DEX (0.5 mcg/kg) to 20 ml of 0.25% levobupivacaine on each side in the TAP block in patients undergoing total abdominal hysterectomy (TAH). Materials and methods Two groups of 30 patients each, with ASA grades 1 and 2, were randomly selected from patients. Group N, comprising 30 patients, had a bilateral TAP block using 2 mL of normal saline and 20 mL of 0.25% levobupivacaine. Group D (n = 30 patients) was given DEX at a dose of 0.5 mcg/kg (2 mL) in addition to 20 mL of 0.25% levobupivacaine given bilaterally. The TAP block was administered just after skin closure. Time of the initial analgesic dose administration; total fentanyl doses utilized as rescue analgesia; pain scores (numerical rating scale (NRS)) at 2, 4, 6, 8, 12, and 24 hours; and pre- and postoperative cortisol levels were also noted. For each group, 1 gram IV paracetamol was administered every eight hours. Drugs used for rescue analgesia (RA) were diclofenac 75 mg IV stat and fentanyl 1 mcg/kg. Results and discussion In addition to Group N having lower NRS scores at rest, Group D had a considerably longer time for initial rescue analgesia than Group N. There was also a significant decrease in the total fentanyl consumption and postoperative serum cortisol levels in Group D in contrast to Group N. Conclusion Potential adjuvant DEX prolongs postoperative analgesia in patients experiencing abdominal hysterectomy when used alongside LA in TAP.
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Affiliation(s)
- Romi Romi
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Wasimul Hoda
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Sourabh Kumar
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Bharati Bharati
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Saurabh Toppo
- Anaesthesiology, Bhagwan Mahavir Medica Superspecialty Hospital, Ranchi, IND
| | - Dipali Singh
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Priyanka Oraon
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Reena Kumari
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Alka Lakra
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Shio Priye
- Superspeciality Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
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Yang F, Hua Q, Zhu X, Xu P. Surgical stress induced tumor immune suppressive environment. Carcinogenesis 2024; 45:185-198. [PMID: 38366618 DOI: 10.1093/carcin/bgae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/25/2024] [Accepted: 02/14/2024] [Indexed: 02/18/2024] Open
Abstract
Despite significant advances in cancer treatment over the decades, surgical resection remains a prominent management approach for solid neoplasms. Unfortunately, accumulating evidence suggests that surgical stress caused by tumor resection may potentially trigger postoperative metastatic niche formation. Surgical stress not only activates the sympathetic-adrenomedullary axis and hypothalamic-pituitary-adrenocortical axis but also induces hypoxia and hypercoagulable state. These adverse factors can negatively impact the immune system by downregulating immune effector cells and upregulating immune suppressor cells, which contribute to the colonization and progression of postoperative tumor metastatic niche. This review summarizes the effects of surgical stress on four types of immune effector cells (neutrophils, macrophages, natural killer cells and cytotoxic T lymphocytes) and two types of immunosuppressive cells (regulatory T cells and myeloid-derived suppressor cells), and discusses the immune mechanisms of postoperative tumor relapse and progression. Additionally, relevant therapeutic strategies to minimize the pro-tumorigenic effects of surgical stress are elucidated.
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Affiliation(s)
- Fan Yang
- Department of Anesthesiology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Research Center for Neuro-Oncology Interaction, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, China
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Qing Hua
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiaoyan Zhu
- Department of Physiology, Navy Medical University, 800 Xiangyin Road, Shanghai 200433, China
| | - Pingbo Xu
- Department of Anesthesiology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Research Center for Neuro-Oncology Interaction, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, China
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Fadhlurrahman AF, Setiawan P, Sumartono C, Perdhana F, Husain TA. The effect of pectointercostal fascial block on stress response in open heart surgery. Saudi J Anaesth 2024; 18:70-76. [PMID: 38313701 PMCID: PMC10833016 DOI: 10.4103/sja.sja_349_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/19/2023] [Accepted: 06/04/2023] [Indexed: 02/06/2024] Open
Abstract
Background Activation of the hypothalamus-pituitary-adrenal (HPA) axis and inflammatory processes are common forms of stress response. The increased stress response is associated with a higher chance of complications. Open hearth surgery is one of the procedures with a high-stress response. Pectointercostal fascial block (PIFB), as a new pain management option in sternotomy, has the potential to modulate the stress response. Objective To determine the effect of PIFB on stress response in open heart surgery. Methods This study was a Randomized Controlled Trial on 40 open heart surgery. Patients were divided into two groups, control (20 patients) and PIFB (20 patients). Primary parameters included basal and postoperative TNF-α, basal and post sternotomy ACTH, and basal, 0, and 24 hours postoperative NLR. Secondary parameters include the amount of opioid use, length of the post-operative ventilator, length of ICU stay, and Numeric Rating Scale (NRS) 6, 12, 24, and 48 hours postoperative. Results The PIFB group had a decrease in ACTH levels with an average change that was not significantly different from the control group (-57.71 ± 68.03 vs. -129.78 ± 140.98). The PIFB group had an average change in TNFα levels and an average increase in NLR 0 hours postoperative that was not significantly lower than the control group (TNFα: -0.52 ± 1.31 vs. 0.54 ± 1.76; NLR: 12.80 ± 3.51 vs. 14.82 ± 4.23). PIFB significantly reduced the amount of opioid use during surgery, NRS at 6, 12, and 24 hours, and the length of post-operative ventilator use (P < 0.05, CI: 95%). Conclusion PIFB has a good role in reducing the stress response of open heart surgery and producing good clinical outcomes.
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Affiliation(s)
- Ahmad Feza Fadhlurrahman
- Department of Anesthesiology and Intensive Therapy, Medical Faculty of Airlangga University, Surabaya, Indonesia
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Brawijaya University, Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - Philia Setiawan
- Division of Cardiovascular and Thoracic Anesthesia, Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Airlangga University, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Christijogo Sumartono
- Division of Regional Anesthesia, Department of Anesthesiology and Intensive Theraoy, Faculty of Medicine, Airlangga University, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Fajar Perdhana
- Division of Cardiovascular and Thoracic Anesthesia, Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Airlangga University, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Teuku Aswin Husain
- Division of Cardiovascular and Thoracic Anesthesia, Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Airlangga University, Dr. Soetomo General Hospital, Surabaya, Indonesia
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Li Y, Wang L, Sun J, Xie T, Fu J, Feng C, Lu G. Effects of Subcostal Anterior Quadratus Lumborum Block with and without Dexmedetomidine on Postoperative Rehabilitation in Patients Undergoing Laparoscopic Renal Surgery: A Prospective Double-Blinded Randomized Controlled Study. Drug Des Devel Ther 2023; 17:3281-3293. [PMID: 38024533 PMCID: PMC10644893 DOI: 10.2147/dddt.s422356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Background The combination of different anesthesia techniques or adjuvant drugs can relieve the stress response to surgery, reduce adverse reactions and improve the clinical outcome. We investigated the effects of subcostal anterior quadratus lumborum block (SQLB) with and without dexmedetomidine (DEX) on postoperative rehabilitation for laparoscopic renal surgery (LRS). Methods We included 90 patients in this single-center study. All were scheduled for elective laparoscopic radical or partial nephrectomy under general anesthesia (GA). We randomly and evenly assigned them to three groups: Group GA (GA alone), Group QG (SQLB with 30 mL of 0.25% ropivacaine and GA), and Group DQG (SQLB with 30 mL of 0.25% ropivacaine plus 1 μg/kg DEX and GA). The primary outcomes were serum creatinine (Cr) and blood urea nitrogen (BUN) levels; the secondary outcomes included the average numeric rating scale (NRS) scores at rest and during activity within 48 h postoperatively; perioperative opioid consumption; the time to first ambulation, exhaust, and fluid intake, and postoperative adverse reactions. Results The serum Cr and BUN levels in Group DQG decreased significantly compared with Group GA (P < 0.05). The average NRS scores in Group DQG were significantly lower than other two groups (P < 0.05). Furthermore, the indexes reduced significantly in Group QG compared with Group GA (P < 0.05). Groups DQG and QG had lower consumption of opioid compared with Group GA (P < 0.05). The recovery indicators in Groups DQG and QG were higher quality than Group GA (P < 0.05). The incidences of adverse reactions in Group DQG was significantly lower than the other groups (P < 0.05). Conclusion SQLB with and without DEX could attenuate postoperative pain, reduce opioids requirement and side effects, as well as facilitate postoperative early rehabilitation. More interesting, SQLB with DEX could confer kidney protection. Clinical Trial Registration Number The Chinese Clinical Trial Registry (ChiCTR2200061554).
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Affiliation(s)
- Youqin Li
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
- Department of Anesthesiology, First People's Hospital of Jinan, Jinan, 250011, People's Republic of China
| | - Lulu Wang
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Jing Sun
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Tian Xie
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Jia Fu
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Chang Feng
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Guodong Lu
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
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Iwasaki M, Zhao H, Hu C, Saito J, Wu L, Sherwin A, Ishikawa M, Sakamoto A, Buggy D, Ma D. The differential cancer growth associated with anaesthetics in a cancer xenograft model of mice: mechanisms and implications of postoperative cancer recurrence. Cell Biol Toxicol 2023; 39:1561-1575. [PMID: 35953652 PMCID: PMC10425502 DOI: 10.1007/s10565-022-09747-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/06/2022] [Indexed: 12/13/2022]
Abstract
Anaesthetics may modify colorectal cancer cell biology which potentially affects long-term survival. This study aims to compare propofol and sevoflurane regarding with the direct anaesthetic effects on cancer malignancy and the indirect effects on host immunity in a cancer xenograft mode of mice. Cultured colon cancer cell (Caco-2) was injected subcutaneously to nude mice (day 1). Mice were exposed to either 1.5% sevoflurane for 1.5 h or propofol (20 μg g-1; ip injection) with or without 4 μg g-1 lipopolysaccharide (LPS; ip) from days 15 to 17, compared with those without anaesthetic exposure as controls. The clinical endpoints including tumour volumes over 70 mm3 were closely monitored up to day 28. Tumour samples from the other cohorts were collected on day 18 for PCR array, qRT-PCR, western blotting and immunofluorescent assessment. Propofol treatment reduced tumour size (mean ± SD; 23.0 ± 6.2mm3) when compared to sevoflurane (36.0 ± 0.3mm3) (p = 0.008) or control (23.6 ± 4.7mm3). Propofol decreased hypoxia inducible factor 1α (HIF1α), interleukin 1β (IL1β), and hepatocyte growth factor (HGF) gene expressions and increased tissue inhibitor of metalloproteinases 2 (TIMP-2) gene and protein expression in comparison to sevoflurane in the tumour tissue. LPS suppressed tumour growth in any conditions whilst increased TIMP-2 and anti-cancer neutrophil marker expressions and decreased macrophage marker expressions compared to those in the LPS-untreated groups. Our data indicated that sevoflurane increased cancer development when compared with propofol in vivo under non-surgical condition. Anaesthetics tested in this study did not alter the effects of LPS as an immune modulator in changing immunocyte phenotype and suppressing cancer development.
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Affiliation(s)
- Masae Iwasaki
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, 369 Fulham Rd, Chelsea, London, SW10 9NH UK
- Department of Anaesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Hailin Zhao
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, 369 Fulham Rd, Chelsea, London, SW10 9NH UK
| | - Cong Hu
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, 369 Fulham Rd, Chelsea, London, SW10 9NH UK
| | - Junichi Saito
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, 369 Fulham Rd, Chelsea, London, SW10 9NH UK
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Lingzhi Wu
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, 369 Fulham Rd, Chelsea, London, SW10 9NH UK
| | - Aislinn Sherwin
- Anaesthesiology and Perioperative Medicine, Mater University Hospital, University College Dublin, Dublin, Ireland
| | - Masashi Ishikawa
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, 369 Fulham Rd, Chelsea, London, SW10 9NH UK
- Department of Anaesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Atsuhiro Sakamoto
- Department of Anaesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Donal Buggy
- Anaesthesiology and Perioperative Medicine, Mater University Hospital, University College Dublin, Dublin, Ireland
| | - Daqing Ma
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, 369 Fulham Rd, Chelsea, London, SW10 9NH UK
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Ajayan N, Hrishi AP, Mathew O, Saravanan G. Evaluation and correlation of nociceptive response index and spectral entropy indices as monitors of nociception in anesthetized patients. J Neurosci Rural Pract 2023; 14:440-446. [PMID: 37692802 PMCID: PMC10483196 DOI: 10.25259/jnrp_75_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/12/2023] [Indexed: 09/12/2023] Open
Abstract
Objectives During anesthesia, the response to these stimuli depends on the balance between nociception and antinociception. Recently, various monitoring systems based on the variables derived from electroencephalography, plethysmography, autonomic tone, reflex pathways, and composite algorithms have been introduced for monitoring nociception. The main aim of our study was to evaluate and correlate the physiological variables which reflect the autonomic nervous system response to nociception, such as heart rate (HR), systolic blood pressure (SBP), perfusion index (PI), and nociceptive response index (NRI), with the spectral entropy indices response entropy (RE) and RE-state entropy (SE), which reflects electromyographic (EMG) activation as a response to pain. Materials and Methods This is a retrospective analysis of the data from a prospective study on the hypnotic and analgesic effects and the recovery profile of sevoflurane-based general anesthesia. Eighty-six patients undergoing single-agent sevoflurane anesthesia were recruited in the study. The study parameters, HR, SBP, SE, RE, RE-SE, PI, and NRI, were recorded at predefined time points before and after a standardized noxious stimulus. Correlation between the variables was carried out by applying the Pearson correlation equation for normal and the Spearman correlation equation for non-normally distributed data. Receiver operating characteristic (ROC) graphs were plotted, and the area under the curve was calculated to assess the diagnostic accuracy of post-stimulus NRI in detecting pain which was defined as RE-SE >10. Results There was a significant increase in the SBP, HR, NRI, RE, SE, and RE-SE and a considerable decrease in PI values during the post-noxious period compared to the pre-noxious period. There was no correlation between the absolute values of NRI and entropy indices at T2. However, among the reaction values, there was a weak correlation between the reaction values of NRI and RE (r = 0.30; P = 0.05). The area under the ROC curve for NRI to detect pain as defined by RE-SE >10 was 0.56. Conclusion During sevoflurane anesthesia, the application of noxious stimulus causes significant changes in variables reflecting sympathetic response and EMG activity. However, NRI failed to detect nociception, and there was only a weak correlation between the reaction values of NRI and RE-SE.
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Affiliation(s)
- Neeraja Ajayan
- Department of Neuroanesthesia and Critical Care, National Institute for Neurology and Neurosurgery, University College of London NHS Hospital Trust, London, United Kingdom
| | - Ajay Prasad Hrishi
- Department of Neuroanesthesia and Critical Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Oommen Mathew
- Department of Biostatics, University of Kerala, Thiruvananthapuram, Kerala, India
| | - Gourinandan Saravanan
- Department of Chemistry and Biochemistry, University of Maryland, Baltimore, United States
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Li H, Li J, Hao C, Luan H, Zhang X, Zhao Z. Effects of anesthetic depth on perioperative T lymphocyte subsets in patients undergoing laparoscopic colorectal cancer surgery: a prospective, parallel-controlled randomized trial. BMC Anesthesiol 2023; 23:165. [PMID: 37189020 DOI: 10.1186/s12871-023-02129-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/09/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND During the perioperative period, the surgical stress response induced by surgical trauma tends to cause a decrease in peripheral lymphocytes. Anesthetics could reduce the stress response during surgery and prevent sympathetic nerve overexcitation. The goal of this study was to investigate how BIS-guided anesthetic depth affected peripheral T lymphocytes in patients undergoing laparoscopic colorectal cancer surgery. METHODS A total of 60 patients having elective laparoscopic colorectal cancer surgery were randomly assigned and analyzed (n = 30 for deep general anesthesia, BIS 35, n = 30 for light general anesthesia, BIS 55). Blood samples were collected immediately before anesthesia induction and immediately after operation, 24 h and 5 days postoperatively. The CD4+/CD8 + ratio, T lymphocyte subsets (including CD3 + T cells, CD4 + T cells, and CD8 + T cells), and natural killer (NK) cells were analyzed by flow cytometry. Serum interleukin-6 (IL-6), interferon -ɣ (IFN-ɣ), and vascular endothelial growth factor-α (VEGF-α) were also measured. RESULTS The CD4+/CD8 + ratio decreased 24 h after surgery in two groups, but the reduction did not differ between the two groups (P > 0.05). The concentration of IL-6 and the numerical rating scale (NRS) score in the BIS 55 group were significantly higher than that in the BIS 35 group 24 h after surgery (P = 0.001). There were no intergroup differences in CD3 + T cells, CD4 + T cells, CD8 + T cells, NK cells, VEGF-α, or the IFN-ɣ. Statistical analyses showed no differences between the two groups in the incidence of fever and surgical site infection during hospitalization. CONCLUSIONS Despite the fact that patients in deep general anesthesia group had low levels of the IL-6 24 h after surgery, the deep general anesthesia was not associated to a positive effect on patients' peripheral T lymphocytes during colorectal cancer surgery. We found no evidence that peripheral T lymphocyte subsets and natural killer cells were affected by the targeting a BIS of either 55 or 35 in patients undergoing laparoscopic colorectal cancer surgery in this trial. TRIAL REGISTRATION ChiCTR2200056624 ( www.chictr.org.cn ).
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Affiliation(s)
- Han Li
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, Lianyungang, 222000, China
| | - Jiachi Li
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, Lianyungang, 222000, China
| | - Conghui Hao
- Jinzhou Medical University, No.40 Songpo Road, Jinzhou, Jinzhou, 121010, China
| | - Hengfei Luan
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, Lianyungang, 222000, China
| | - Xiaobao Zhang
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, Lianyungang, 222000, China
| | - Zhibin Zhao
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, Lianyungang, 222000, China.
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10
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Giordano F, Giglio M, Sorrentino I, Dell'Olio F, Lorusso P, Massaro M, Tempesta A, Limongelli L, Selicato L, Favia G, Varrassi G, Puntillo F. Effect of Preoperative Music Therapy Versus Intravenous Midazolam on Anxiety, Sedation and Stress in Stomatology Surgery: A Randomized Controlled Study. J Clin Med 2023; 12:jcm12093215. [PMID: 37176656 PMCID: PMC10179016 DOI: 10.3390/jcm12093215] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Patients undergoing surgery and general anesthesia often experience anxiety, fear and stress, with negative bodily responses. These may be managed by the pre-procedural application of anxiolytic, analgesic, and anesthetic drugs that have, however, potential risks or side effects. Music therapy (MT) can be used as a complementary no-drug intervention alongside standard surgical care before, during and after medical procedures. The aim of this study was to evaluate the effects of preoperative MT intervention compared to premedication with midazolam on levels of anxiety, sedation and stress during general anesthesia for elective stomatology surgery. METHODS A two-arm randomized and controlled single-center, parallel-group, pre-post event study was conducted. In total, 70 patients affected by stage I or II (both clinically and instrumentally N0) micro-invasive oral cancer and undergoing elective surgery under general anesthesia were assigned to the control group (CG) or to the music therapy group (MTG). MTG patients received preoperative music therapy intervention (MT) from a certified music therapist before surgery, while the CG patients did not receive MT but instead received premedication with intravenous midazolam, 0.02 mg/kg. Anesthesia was the same in both groups. The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were recorded at the entrance to the operating room, just before the induction of anesthesia and every 5 min until the end of surgery. An anxiety visual analogues scale (A-VAS) was used to evaluate the level of anxiety. The bispectral index (BIS) monitor was used to measure the depth of sedation just before and 10 min after both music intervention and midazolam administration. Stress response was assessed 5 min before and 20 min after surgery via the control of plasma prolactin (PRL), growth hormone (GH), and cortisol levels. The patient global impression of satisfaction (PGIS) was tested 1 h after surgery. Participants in the MTG were asked to answer 3 questions concerning their experience with MT. RESULTS No statistical differences among the PRL, GH and cortisol levels between the two groups were registered before and after the treatment, as well as for PAS, PAD and HR. Significant differences in the A-VAS scores between the MTG and CG (p < 0.01) was observed. Compared to the CG, MTG patients had a statistically significantly lower BIS score (p = 0.02) before induction. A PGIS score of 86.7% revealed that patients in the MTG were very satisfied, versus 80% in the CG (p < 0.05). CONCLUSION Preoperative music therapy could be an alternative to intravenous midazolam when aiming to promote a preoperative and post-operative state of anxiolysis and sedation in stomatology surgery, even if no differences were found in terms of the surgery-related stress response according to physiological and hormonal determinations.
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Affiliation(s)
- Filippo Giordano
- Department of Precision and Regenerative Medicine and Ionian Area, Aldo Moro University, 70124 Bari, Italy
| | - Mariateresa Giglio
- Department of Interdisciplinary Medicine, Aldo Moro University, 70124 Bari, Italy
| | - Irene Sorrentino
- Department of Precision and Regenerative Medicine and Ionian Area, Aldo Moro University, 70124 Bari, Italy
| | - Fabio Dell'Olio
- Department of Mathematic, Aldo Moro University, 70124 Bari, Italy
| | - Pantaleo Lorusso
- Department of Precision and Regenerative Medicine and Ionian Area, Aldo Moro University, 70124 Bari, Italy
| | - Maria Massaro
- Department of Precision and Regenerative Medicine and Ionian Area, Aldo Moro University, 70124 Bari, Italy
| | - Angela Tempesta
- Department of Interdisciplinary Medicine, Aldo Moro University, 70124 Bari, Italy
| | - Luisa Limongelli
- Department of Interdisciplinary Medicine, Aldo Moro University, 70124 Bari, Italy
| | - Laura Selicato
- Department of Mathematic, Aldo Moro University, 70124 Bari, Italy
| | - Gianfranco Favia
- Department of Interdisciplinary Medicine, Aldo Moro University, 70124 Bari, Italy
| | - Giustino Varrassi
- Department of Research, Paolo Procacci Foundation, 00193 Roma, Italy
| | - Filomena Puntillo
- Department of Interdisciplinary Medicine, Aldo Moro University, 70124 Bari, Italy
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11
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Wang L, Li Y, Yin X, Han Q, Feng Y, Shi Y, Liu G, Sun L. Anesthesia management in a patient with anomalous origin of left pulmonary artery from the descending aorta: A case report and literature review. Front Surg 2023; 10:1140212. [PMID: 37009604 PMCID: PMC10050451 DOI: 10.3389/fsurg.2023.1140212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/16/2023] [Indexed: 03/17/2023] Open
Abstract
Anomalous origin of the left pulmonary artery from the descending aorta is an extremely rare congenital malformation. There were merely four case reports of such malformation in previous literature, and all four cases underwent surgical repair in their first year of life. Actually, long-term pulmonary arterial hypertension and irreversible pulmonary vascular changes make anesthesia management quite a challenge, while anesthesia for managing these cases has not been discussed before. We present a 15-year-old boy undergoing corrective surgery and try to provide some tips on anesthesia management for this surgical procedure. Through optimal perioperative management, successful outcomes can be achieved for this malformation.
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Affiliation(s)
- Lu Wang
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
| | - Yaru Li
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
| | - Xinrui Yin
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
| | - Qiaoyu Han
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
| | - Yi Feng
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
| | - Yi Shi
- Department of Cardiac Surgery, Peking University People’s Hospital, Beijing, China
| | - Gang Liu
- Department of Cardiac Surgery, Peking University People’s Hospital, Beijing, China
| | - Liang Sun
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
- Correspondence: Liang Sun
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12
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Li J, Kang G, Liu T, Liu Z, Guo T. Feasibility of Enhanced Recovery After Surgery Protocols Implemented Perioperatively in Endoscopic Submucosal Dissection for Early Gastric Cancer: A Single-Center Retrospective Study. J Laparoendosc Adv Surg Tech A 2023; 33:74-80. [PMID: 35723625 DOI: 10.1089/lap.2022.0269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) has advantages over traditional radical gastrectomy. We investigated whether enhanced recovery after surgery (ERAS) protocols are appropriate in the ESD perioperative period. Materials and Methods: We screened 129 consecutive patients, and 12 were excluded. All study patients underwent ESD for EGC. Of the 117 included patients, 57 received traditional perioperative care between January 2017 and December 2018, and 60 patients received perioperative care according to ERAS protocols between January 2019 and September 2020. The primary study endpoint was ESD-related complications. Secondary endpoints included the following postoperative parameters: anal exhaust time, incidence of nausea or vomiting, length of hospitalization, fever rate, abdominal pain on the visual analog scale (VAS), and reported perioperative satisfaction. Results: Complications were comparable between the 2 groups. In the ERAS group, no patients experienced delayed bleeding or perforation. One traditional group patient bled, and one perforated. Postoperative anal exhaust time, nausea or vomiting incidence, hospitalization, fever rate, and VAS pain scores were significantly lower, and perioperative satisfaction rate was significantly higher in the ERAS group. Conclusions: ERAS protocols are both feasible and safe for patients undergoing ESD. ERAS protocols enhance the advantages of ESD for EGC without increasing complications.
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Affiliation(s)
- Junliang Li
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China.,Department of General Surgical, Gansu Provincial Hospital, Lanzhou, China.,The First School of Clinical Medical, Gansu University of Chinese Medicine, Lanzhou, China
| | - Guolan Kang
- Department of Endoscopic Center, Gansu Provincial Hospital, Lanzhou, China
| | - Tianxiang Liu
- Department of General Surgical, Gansu Provincial Hospital, Lanzhou, China
| | - Zongshu Liu
- Department of General Surgical, Gansu Provincial Hospital, Lanzhou, China
| | - Tiankang Guo
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China.,Department of General Surgical, Gansu Provincial Hospital, Lanzhou, China
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13
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Zangl Q, Kaiser A, Iglseder B. Psychotherapy: A tool to prevent postoperative delirium? J Perioper Pract 2023; 33:48-52. [PMID: 35225713 DOI: 10.1177/17504589211059333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The value of psychotherapy in surgical patients suffering from postoperative delirium is unclear. Options for the treatment of established postoperative delirium are few; therapy largely relies on the avoidance of postoperative delirium facilitating factors, like specific drugs and environmental factors in the perioperative setting. Established medical therapies' efficacy in terms of decreasing incidence of postoperative delirium is very low. The aim of this project is to suggest new therapeutic options in the form of cognitive behavioural therapy as a possible preventive and psychotherapeutic treatment of postoperative delirium. Life expectancy in developed countries increases worldwide and both the need for surgical treatment and the probability of postoperative delirium occurrence increase with age. Due to the necessity of addressing the individual's negative consequences of postoperative delirium and to optimise socioeconomical needs, new therapeutic options for the treatment of postoperative delirium are desperately needed.
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Affiliation(s)
- Quirin Zangl
- Department of Neuroanesthesia, Christian Doppler Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Kaiser
- Department of Clinical Psychology, Christian Doppler Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Iglseder
- Department of Geriatrics, Christian Doppler Hospital, Paracelsus Medical University, Salzburg, Austria
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14
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Sharma M, Dietz N, Scott V, Wang D, Ugiliweneza B, Boakye M. Trends and Outcomes in Patients with Dementia Undergoing Spine Fusions: A Matched Nationwide Inpatient Sample Analysis. World Neurosurg 2023; 169:e164-e170. [PMID: 36332775 DOI: 10.1016/j.wneu.2022.10.099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/22/2022] [Accepted: 10/25/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of our study was to define the trends and outcomes in patients with a preexisting diagnosis of dementia who underwent spine fusions using a large national database. METHODS The Nationwide Inpatient Sample database was queried using the International Classification of Diseases, Ninth Revision and Tenth Revision, from 1998 to 2018. We included patients who underwent spine fusions with or without the diagnosis of dementia. Outcomes were trends, complications, length of stay (LOS), discharge disposition, and mortality. RESULTS A cohort of 4495 patients (N = 1,390,657; 0.32%) with dementia who underwent spine fusions was identified. There was an increasing trend of spine fusions in patients with the diagnosis of dementia. Most patients with dementia were white (77% vs. 69%), with ≥3 comorbidities (70% vs. 23%), had Medicare insurance (83% vs. 34%) compared with patients without dementia (P < 0.0001). Overall, 38% of patients had complications after spine fusions compared with 21% of patients without dementia during the study period. Median LOS was significantly longer in patients with dementia compared with patients without dementia (6 vs. 4 days). Patients with dementia were less likely to be discharged home (19% vs. 40%) and incurred higher in-hospitalization charges ($139,101 vs. $101,629) compared with patients without dementia. No differences in terms of in-hospital mortality were noted across the cohorts (1.4% vs. 1.6%). CONCLUSIONS Patients with dementia had 1.5 times longer LOS and 1.4 times higher index hospitalization charges and were 2.5 times more likely to have complications and 71% less likely to be discharged home, with no difference in mortality compared with patients without dementia after spine fusions.
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Affiliation(s)
- Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
| | - Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Victoria Scott
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA; Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA; Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA; Department of Health Management and Systems Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA; Department of Health Management and Systems Sciences, University of Louisville, Louisville, Kentucky, USA
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15
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Hypoxia-triggered O-GlcNAcylation in the brain drives the glutamate-glutamine cycle and reduces sensitivity to sevoflurane in mice. Br J Anaesth 2022; 129:703-715. [PMID: 36031420 DOI: 10.1016/j.bja.2022.06.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 06/11/2022] [Accepted: 06/29/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hypersensitivity to general anaesthetics predicts adverse postoperative outcomes in patients. Hypoxia exerts extensive pathophysiological effects on the brain; however, whether hypoxia influences sevoflurane sensitivity and its underlying mechanisms remain poorly understood. METHODS Mice were acclimated to hypoxia (oxygen 10% for 8 h day-1) for 28 days and anaesthetised with sevoflurane; the effective concentrations for 50% of the animals (EC50) showing loss of righting reflex (LORR) and loss of tail-pinch withdrawal response (LTWR) were determined. Positron emission tomography-computed tomography, O-glycoproteomics, seahorse analysis, carbon-13 tracing, site-specific mutagenesis, and electrophysiological techniques were performed to explore the underlying mechanisms. RESULTS Compared with the control group, the hypoxia-acclimated mice required higher concentrations of sevoflurane to present LORR and LTWR (EC50LORR: 1.61 [0.03]% vs 1.46 [0.04]%, P<0.01; EC50LTWR: 2.46 [0.14]% vs 2.22 [0.06]%, P<0.01). Hypoxia-induced reduction in sevoflurane sensitivity was correlated with elevation of protein O-linked N-acetylglucosamine (O-GlcNAc) modification in brain, especially in the thalamus, and could be abolished by 6-diazo-5-oxo-l-norleucine, a glutamine fructose-6-phosphate amidotransferase inhibitor, and mimicked by thiamet-G, a selective O-GlcNAcase inhibitor. Mechanistically, O-GlcNAcylation drives de novo synthesis of glutamine from glucose in astrocytes and promotes the glutamate-glutamine cycle, partially via glycolytic flux and activation of glutamine synthetase. CONCLUSIONS Intermittent hypoxia exposure decreased mouse sensitivity to sevoflurane anaesthesia through enhanced O-GlcNAc-dependent modulation of the glutamate-glutamine cycle in the brain.
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16
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Zhang H, Qu M, Guo K, Wang Y, Gu J, Wu H, Zhu X, Sun Z, Cata JP, Chen W, Miao C. Intraoperative lidocaine infusion in patients undergoing pancreatectomy for pancreatic cancer: a mechanistic, multicentre randomised clinical trial. Br J Anaesth 2022; 129:244-253. [PMID: 35697547 DOI: 10.1016/j.bja.2022.03.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/27/2022] [Accepted: 03/08/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Intravenous lidocaine has been postulated to improve long-term survival after surgery for pancreatic cancer through anti-inflammatory effects, anti-tumour effects, or both. We investigated whether intraoperative lidocaine improves survival after pancreatectomy for pancreatic cancer and whether lidocaine modified the formation of neutrophil extracellular traps (NETs), high levels of which are associated with poor prognosis. METHODS Patients undergoing pancreatectomy were randomly assigned to i.v. lidocaine (continuous intraoperative infusion of 2 mg kg-1 h-1, after 1.5 mg kg-1 bolus at induction of anaesthesia) or saline placebo. The co-primary outcomes were survival/disease-free survival 3 yr after surgery. Secondary outcomes (masked to treatment allocation) included intraoperative opioid (sufentanil) dose, postoperative complications, and circulating and tumour-associated NETs (immunofluorescence assay, enzyme-linked immune assay, or both). RESULTS A total of 563 participants (34.6% female; median age, 64 yr) completed 3 yr of clinical follow-up. Overall, 283 participants were randomised to lidocaine infusion, and 280 participants were randomised to placebo. Infusion of lidocaine did not alter overall (hazard ratio [HR]=0.98; 95% confidence interval [CI], 0.81-1.17; P=0.79) or disease-free survival (HR=0.91; 95% CI, 0.71-1.17; P=0.44). Mean intraoperative sufentanil dose was reduced by lidocaine infusion (47.6 μg [4.6]) compared with placebo (68.4 μg [4.8]; P<0.001), but postoperative complications and length of hospital stay were similar between groups. Circulating NETs were lower after lidocaine infusion up to 3 days after surgery, but tumour-associated NETs were not altered by intraoperative treatment. CONCLUSION In patients undergoing pancreatectomy for pancreatic cancer, intraoperative infusion of lidocaine did not improve overall or disease-free survival. Reduced formation of circulating NETs was absent in pancreatic tumour tissue. CLINICAL TRIAL REGISTRATION NCT03245346; updated in Chi-CTR-2000035469.
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Affiliation(s)
- Hao Zhang
- Department of Anaesthesiology, Zhongshan Hospital, Shanghai, China; Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai, China
| | - Mengdi Qu
- Department of Anaesthesiology, Zhongshan Hospital, Shanghai, China; Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai, China
| | - Kefang Guo
- Department of Anaesthesiology, Zhongshan Hospital, Shanghai, China; Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai, China
| | - Yanghanzhao Wang
- Department of Anaesthesiology, Zhongshan Hospital, Shanghai, China; Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai, China
| | - Jiahui Gu
- Department of Anaesthesiology, Zhongshan Hospital, Shanghai, China; Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai, China
| | - Han Wu
- Department of Anaesthesiology, Zhongshan Hospital, Shanghai, China; Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai, China
| | - Xuqin Zhu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Anaesthesiology, Fudan University Shanghai Cancer Centre, Shanghai, China
| | - Zhirong Sun
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Anaesthesiology, Fudan University Shanghai Cancer Centre, Shanghai, China
| | - Juan P Cata
- Department of Anaesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Centre, Houston, TX, USA; Anaesthesiology and Surgical Oncology Research Group, Houston, TX, USA.
| | - Wankun Chen
- Department of Anaesthesiology, Zhongshan Hospital, Shanghai, China; Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai, China.
| | - Changhong Miao
- Department of Anaesthesiology, Zhongshan Hospital, Shanghai, China; Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai, China.
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17
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Zhang H, Qu M, Sun C, Wang Y, Li T, Xu W, Sun Z, Zhang X, Guo K, Chen W, Sun M, Miao C. Association of Mu-Opioid Receptor Expression With Long-Term Survival and Perineural Nerve Invasion in Patients Undergoing Surgery for Ovarian Cancer. Front Oncol 2022; 12:927262. [PMID: 35875149 PMCID: PMC9302566 DOI: 10.3389/fonc.2022.927262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundOpioids are widely used during primary debulking surgery (PDS) for ovarian cancers, and a high mu-opioid receptor (MOR) expression predicts worse cancer outcomes. However, the impact of MOR expression on survival outcomes in ovarian cancers is still not clear.MethodsA retrospective cohort study was conducted in patients who underwent PDS in ovarian cancer patients. MOR expression was measured in tumor and normal tissue. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Secondary outcomes included perineural invasion (PNI), intraoperative sufentanil consumption, length of stay (LOS), and verbal numerical rating scale (VNRS) on postoperative day 1 (POD1), POD3, and POD5.ResultsAfter propensity score matching, a total of 366 patients were finally enrolled in this study. There were no significant differences in OS rates in patients with high versus low levels of MOR (1-year OS: 82.9% versus 83.3%, 3-year: 57.8% versus 59.1%, 5-year: 22.4% versus 23.1%,respectively) in the ovarian cancers. There were no significant differences in DFS between the groups. Intraoperative sufentanil consumption was higher in the MOR high-expression group compared with the MOR low-expression group. Tumors expressing high levels of MOR showed higher rates of PNI. VNRS in the MOR high-expression group was higher on POD1.ConclusionMOR is not an independent predictor of worse survival in ovarian cancers but is associated with high rates of perineural invasion.
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Affiliation(s)
- Hao Zhang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai, China
| | - Mengdi Qu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai, China
| | - Caihong Sun
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai, China
| | - Yanghanzhao Wang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai, China
| | - Ting Li
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai, China
| | - Wei Xu
- Department of Anesthesiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Zhirong Sun
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoguang Zhang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai, China
- Department of Anesthesiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Kefang Guo
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai, China
- *Correspondence: Changhong Miao, ; Wankun Chen, ; Kefang Guo, ; Minli Sun,
| | - Wankun Chen
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai, China
- *Correspondence: Changhong Miao, ; Wankun Chen, ; Kefang Guo, ; Minli Sun,
| | - Minli Sun
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai, China
- *Correspondence: Changhong Miao, ; Wankun Chen, ; Kefang Guo, ; Minli Sun,
| | - Changhong Miao
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai, China
- Department of Anesthesiology, Jinshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Changhong Miao, ; Wankun Chen, ; Kefang Guo, ; Minli Sun,
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18
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Henn D, Barrera JA, Sivaraj D, Lin JQ, Rizk NM, Ma I, Gurtner GC, Lee GK, Nazerali RS. Combining Breast and Ovarian Operations Increases Complications. Plast Reconstr Surg 2022; 149:1050-1059. [PMID: 35245249 DOI: 10.1097/prs.0000000000008984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast cancer resulting from a genetic mutations, such as BRCA1 or BRCA2, is seen in 5 to 10 percent of patients. More widespread genetic testing has increased the number of affected women undergoing prophylactic mastectomy and oophorectomy. Recent studies have yielded mixed results regarding complication rates after combined breast and ovarian operations. The authors compared surgical outcomes of breast operations performed in combination with salpingo-oophorectomies or as separate procedures. METHODS The authors retrospectively analyzed surgical complications and length of hospital stay in 145 female patients, from which 87 had undergone combined breast surgery and salpingo-oophorectomy, and 58 had undergone these procedures separately. Multivariate logistic regression models were used to calculate odds ratios and 95 percent confidence intervals. RESULTS Patients undergoing combined breast and ovarian operations experienced higher rates of overall complications (46.5 percent versus 19 percent; p < 0.001), infections (22.2 percent versus 8.6 percent; p < 0.05), and delayed wound healing (13.2 percent versus 0 percent; p < 0.05) related to the breast surgery, when compared with patients undergoing separate procedures. Multivariate logistic regression analysis confirmed a significant association between combined surgery and overall postoperative complications (OR, 5.87; 95 percent CI, 2.03 to 16.91; p = 0.02). Patients undergoing tissue expander-based breast reconstruction combined with ovarian surgery had significantly longer hospital stays compared to patients undergoing separate procedures (3.5 days versus 1.8 days; p < 0.001). CONCLUSIONS The authors' data indicate that combining breast and ovarian operations is associated with a higher risk of postoperative complications related to the breast procedure and increases the duration of hospital stay in patients with tissue expander-based reconstructions. The authors' study provides valuable information for preoperative counseling of patients considering both breast and ovarian surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Dominic Henn
- From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
| | - Janos A Barrera
- From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
| | - Dharshan Sivaraj
- From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
| | - John Q Lin
- From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
| | - Nada M Rizk
- From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
| | - Irene Ma
- From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
| | - Geoffrey C Gurtner
- From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
| | - Gordon K Lee
- From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
| | - Rahim S Nazerali
- From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
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19
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Risk of Dementia According to Surgery Type: A Nationwide Cohort Study. J Pers Med 2022; 12:jpm12030468. [PMID: 35330467 PMCID: PMC8955036 DOI: 10.3390/jpm12030468] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 12/19/2022] Open
Abstract
The relationship between dementia and surgery remains unclear. Research to elucidate the relationship between them is scarce, and conducting epidemiological research is complicated. This study aimed to investigate the incidence and risk of dementia according to the surgery type. We performed a retrospective propensity score-matched cohort study using nationwide representative cohort sample data from the Korean National Health Insurance Service in South Korea between 2003 and 2004. Incidence rates for dementia were obtained by dividing the number of patients with dementia by person-years at risk. To identify the risk of dementia according to the type of surgery, we investigated the hazard ratio by each surgery type. The incidence rates of dementia in control, musculoskeletal, and two or more surgeries groups were 9.66, 13.47, and 13.36 cases per 1000 person-years, respectively. The risk of dementia in the musculoskeletal and two or more surgeries groups was 1.44-fold higher (95% confidence interval (95% CI), 1.22–1.70) and 1.42-fold higher (95% CI, 1.17–1.72) than that in the control group, respectively. Patients who underwent musculoskeletal surgery and two or more surgeries had a higher risk of dementia; however, there was no association with the type of anesthesia administered.
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Shen J, Han L, Xue Y, Li C, Jia H, Zhu K. Ropivacaine Inhibits Lung Cancer Cell Malignancy Through Downregulation of Cellular Signaling Including HIF-1α In Vitro. Front Pharmacol 2022; 12:806954. [PMID: 35280249 PMCID: PMC8905340 DOI: 10.3389/fphar.2021.806954] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/28/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Ropivacaine is widely used to induce regional anesthesia during lung cancer surgery. Previous studies reported that amide-linked local anesthetics, e.g., ropivacaine, affected the biological behavior of lung adenocarcinoma cells, but the conclusion is controversial and warrants further study. This study set out to investigate the biological effects of ropivacaine on cultured lung cancer cells and underlying mechanisms. Methods: Lung cancer cell lines (A549 and H1299) were cultured and then treated with or without ropivacaine (0.5, 1, and 2 mM) for 48 or 72 h. Their proliferation, migration, and invasion together with cell death and molecules including hypoxia inducible factor (HIF)-1α, VEGF, matrix metalloproteinase (MMP)-1, MMP-2, and MMP-9 expression associated with these changes were determined. Results: Ropivacaine significantly inhibited proliferation and migration, invasion, and cell death in a concentration-dependent manner in both cell lines. Ropivacaine also promoted cell death and induced a concentration- and time-dependent cell arrest towards the G0/G1 phase. Expression of VEGF, MMP-1, MMP-2, MMP-9, and HIF-1α in both cell lines was also inhibited by ropivacaine in a concentration-related manner. Conclusion: Our data indicated that ropivacaine inhibited lung cancer cell malignancy, which may be associated with downregulation of cell-survival-associated cellular molecules. The translational value of the current work is subjected to further study.
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Affiliation(s)
- Junmei Shen
- Department of Anesthesiology, The Forth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lina Han
- Department of Blood Transfusion, The Forth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yongxian Xue
- Scientific Research Center, The Forth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chao Li
- Department of Anesthesiology, The Forth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huiqun Jia
- Department of Anesthesiology, The Forth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Kangsheng Zhu
- Department of Anesthesiology, The Forth Hospital of Hebei Medical University, Shijiazhuang, China
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Liu L, Shang L, Jin D, Wu X, Long B. General anesthesia bullies the gut: a toxic relationship with dysbiosis and cognitive dysfunction. Psychopharmacology (Berl) 2022; 239:709-728. [PMID: 35187594 DOI: 10.1007/s00213-022-06096-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/15/2022] [Indexed: 12/12/2022]
Abstract
Perioperative neurocognitive disorder (PND) is a common surgery outcome affecting up to a third of the elderly patients, and it is associated with high morbidity and increased risk for Alzheimer's disease development. PND is characterized by cognitive impairment that can manifest acutely in the form of postoperative delirium (POD) or after hospital discharge as postoperative cognitive dysfunction (POCD). Although POD and POCD are clinically distinct, their development seems to be mediated by a systemic inflammatory reaction triggered by surgical trauma that leads to dysfunction of the blood-brain barrier and facilitates the occurrence of neuroinflammation. Recent studies have suggested that the gut microbiota composition may play a pivotal role in the PND development by modulating the risk of neuroinflammation establishment. In fact, modulation of gut microbiome composition with pre- and probiotics seems to be effective for the prevention and treatment of PND in animals. Interestingly, general anesthetics seem to have major responsibility on the gut microbiota composition changes following surgery and, consequently, can be an important element in the process of PND initiation. This concept represents an important milestone for the understanding of PND pathogenesis and may unveil new opportunities for the development of preventive or mitigatory strategies against the development of these conditions. The aim of this review is to discuss how anesthetics used in general anesthesia can interact and alter the gut microbiome composition and contribute to PND development by favoring the emergence of neuroinflammation.
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Affiliation(s)
- Lidan Liu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Lihua Shang
- Department of Anesthesiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Dongxue Jin
- Department of Anesthesiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Xiuying Wu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Bo Long
- Department of Anesthesiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning Province, China.
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22
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Effect of major versus minor mastectomy on host immunity in canine mammary cancer. Vet Immunol Immunopathol 2022; 246:110403. [DOI: 10.1016/j.vetimm.2022.110403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 11/20/2022]
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23
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Effect of anaesthesia for mastectomy on cell-mediated immunity in dogs with mammary cancer. Vet Anaesth Analg 2022; 49:265-274. [DOI: 10.1016/j.vaa.2021.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/29/2021] [Accepted: 09/08/2021] [Indexed: 01/22/2023]
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Kwon YS, Lee JJ, Lee SH, Kim C, Yu H, Sohn JH, Kim DK. Risk of Dementia in Patients Who Underwent Surgery under Neuraxial Anesthesia: A Nationwide Cohort Study. J Pers Med 2021; 11:1386. [PMID: 34945858 PMCID: PMC8708516 DOI: 10.3390/jpm11121386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/17/2022] Open
Abstract
The incidence of dementia in patients with surgery under neuraxial anesthesia and the possibility of surgery under neuraxial anesthesia as a risk factor for dementia were investigated. We performed a retrospective matched cohort study with nationwide, representative cohort sample data of the Korean National Health Insurance Service in South Korea between 1 January 2003, and 31 December 2004. The participants were divided into control (n = 4488) and neuraxial groups (n = 1122) using propensity score matching. After 9 years of follow-up, the corresponding incidences of dementia were 11.5 and 14.8 cases per 1000 person-years. The risk of dementia in the surgery under neuraxial group was 1.44-fold higher (95% confidence interval [95%CI], 1.17-1.76) than that in the control group. In the subgroup analysis of dementia, the risk of Alzheimer's disease in those who underwent surgery under neuraxial anesthesia was 1.48-fold higher (95%CI, 1.17-1.87) than that in those who did not undergo surgery under anesthesia. Our findings suggest that patients who underwent surgery under neuraxial anesthesia had a higher risk of dementia and Alzheimer's disease than those who did not undergo surgery under neuraxial anesthesia.
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Affiliation(s)
- Young-Suk Kwon
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (Y.-S.K.); (J.-J.L.)
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.-H.L.); (C.K.); (H.Y.)
| | - Jae-Jun Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (Y.-S.K.); (J.-J.L.)
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.-H.L.); (C.K.); (H.Y.)
| | - Sang-Hwa Lee
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.-H.L.); (C.K.); (H.Y.)
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea
| | - Chulho Kim
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.-H.L.); (C.K.); (H.Y.)
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea
| | - Hyunjae Yu
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.-H.L.); (C.K.); (H.Y.)
| | - Jong-Hee Sohn
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.-H.L.); (C.K.); (H.Y.)
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea
| | - Dong-Kyu Kim
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.-H.L.); (C.K.); (H.Y.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea
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25
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Lin D, Han Z, Fu Y, Zhu X, Li J, Xu H, Wen J, Wang F, Guo M. Combination of Interscalene Brachial Plexus Block with General Anesthesia Attenuates Stress and Inflammatory Response in Arthroscopic Shoulder Surgery. BIO INTEGRATION 2021. [DOI: 10.15212/bioi-2021-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract In arthroscopic shoulder surgery, general anesthesia (GA) is the common method of anesthesia. Recently, the combined usage of interscalene brachial plexus block with general anesthesia (ISB/GA) was reported to have a lower incidence of adverse side effects than GA
alone. However, to date, no study has compared stress and inflammatory responses between these two methods. Since stress and inflammatory responses are critical on intraoperative management and postoperative recovery, we integrated the laboratory and clinical methods and compared the stress
and inflammatory factors, such as epinephrine, norepinephrine, glucose, lactate, inflammatory factors tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6), as well as the clinical outcomes to determine whether ISB/GA provides an advantage on stress and inflammatory inhibition.
Data showed that ISB/GA resulted in significantly lower epinephrine, norepinephrine, and glucose levels perioperatively. Six hours after operation, the TNF-α and IL-6 levels were also significantly lower in the ISB/GA group. ISB/GA patients had lower blood pressure, a more stable heart
rate, lower visual analog scale score, and less opioid consumption during and after surgery. Our results indicate that ISB/GA is a better choice for arthroscopic shoulder surgery, owing to less stress and inflammatory responses during and after operation, which provides better clinical outcomes.
Therefore, we recommend ISB/GA as a preferred anesthesia method for arthroscopic shoulder surgery.
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Affiliation(s)
- Daowei Lin
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong, China
| | - Zhixiao Han
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong, China
| | - Yanni Fu
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong, China
| | - Xiaoqiu Zhu
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong, China
| | - Jin Li
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong, China
| | - Hui Xu
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong, China
| | - Jing Wen
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Fei Wang
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong, China
| | - Mingyan Guo
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong, China
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Kovács-Ábrahám Z, Aczél T, Jancsó G, Horváth-Szalai Z, Nagy L, Tóth I, Nagy B, Molnár T, Szabó P. Cerebral and Systemic Stress Parameters in Correlation with Jugulo-Arterial CO 2 Gap as a Marker of Cerebral Perfusion during Carotid Endarterectomy. J Clin Med 2021; 10:jcm10235479. [PMID: 34884182 PMCID: PMC8658406 DOI: 10.3390/jcm10235479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/30/2021] [Accepted: 11/21/2021] [Indexed: 11/16/2022] Open
Abstract
Intraoperative stress is common to patients undergoing carotid endarterectomy (CEA); thus, impaired oxygen and metabolic balance may appear. In this study, we aimed to identify new markers of intraoperative cerebral ischemia, with predictive value on postoperative complications during CEA, performed in regional anesthesia. A total of 54 patients with significant carotid stenosis were recruited and submitted to CEA. Jugular and arterial blood samples were taken four times during operation, to measure the jugulo-arterial carbon dioxide partial pressure difference (P(j-a)CO2), and cortisol, S100B, L-arginine, and lactate levels. A positive correlation was found between preoperative cortisol levels and all S100B concentrations. In addition, they are positively correlated with P(j-a)CO2 values. Conversely, postoperative cortisol inversely correlates with P(j-a)CO2 and postoperative S100B values. A negative correlation was observed between maximum systolic and pulse pressures and P(j-a)CO2 after carotid clamp and before the release of clamp. Our data suggest that preoperative cortisol, S100B, L-arginine reflect patients' frailty, while these parameters postoperatively are influenced by intraoperative stress and injury. As a novelty, P(j-a)CO2 might be an emerging indicator of cerebral blood flow during CEA.
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Affiliation(s)
- Zoltán Kovács-Ábrahám
- Department of Anesthesiology and Intensive Care, Medical School, University of Pécs, H-7624 Pécs, Hungary; (Z.K.-Á.); (I.T.); (B.N.); (T.M.)
| | - Timea Aczél
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, H-7624 Pécs, Hungary;
- Molecular Pharmacology Research Group & Centre for Neuroscience, János Szentágothai Research Centre, University of Pécs, H-7624 Pécs, Hungary
| | - Gábor Jancsó
- Department of Vascular Surgery, Medical School, University of Pécs, H-7624 Pécs, Hungary;
| | - Zoltán Horváth-Szalai
- Department of Laboratory Medicine, Medical School, University of Pécs, H-7624 Pécs, Hungary;
| | - Lajos Nagy
- Department of Applied Chemistry, Institute of Chemistry, Faculty of Science and Technology, University of Debrecen, H-4032 Debrecen, Hungary;
| | - Ildikó Tóth
- Department of Anesthesiology and Intensive Care, Medical School, University of Pécs, H-7624 Pécs, Hungary; (Z.K.-Á.); (I.T.); (B.N.); (T.M.)
| | - Bálint Nagy
- Department of Anesthesiology and Intensive Care, Medical School, University of Pécs, H-7624 Pécs, Hungary; (Z.K.-Á.); (I.T.); (B.N.); (T.M.)
| | - Tihamér Molnár
- Department of Anesthesiology and Intensive Care, Medical School, University of Pécs, H-7624 Pécs, Hungary; (Z.K.-Á.); (I.T.); (B.N.); (T.M.)
| | - Péter Szabó
- Department of Anesthesiology and Intensive Care, Medical School, University of Pécs, H-7624 Pécs, Hungary; (Z.K.-Á.); (I.T.); (B.N.); (T.M.)
- Correspondence:
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Ryan A, Gurney M, Steinbacher R. Suspected vagal reflex and hyperkalaemia inducing asystole in an anaesthetised horse. Equine Vet J 2021; 54:927-933. [PMID: 34738246 PMCID: PMC9543672 DOI: 10.1111/evj.13535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/26/2021] [Accepted: 10/18/2021] [Indexed: 12/02/2022]
Abstract
A 10‐year‐old 466 kg mustang gelding presented to an equine referral hospital for surgical repair of nasal, frontal and lacrimal bone fractures from an unknown trauma. Surgical repair was performed under general anaesthesia, including a right‐sided maxillary regional anaesthetic block with mepivacaine hydrochloride. Progressive hyperkalaemia was documented perianaesthetically (T‐3 mins; 134 mins after induction; potassium 6.4 mmol/L (ref 3.5‐5.1 mmol/L). Perianaesthetic bradycardia was attributed to alpha −2 agonist infusion administration, and other characteristic ECG changes (flattened P waves, narrow T waves of increased amplitude, prolonged QRS complex) were not documented. Asystole occurred 137 min after induction of anaesthesia; however, a review of the available literature suggests the degree of hyperkalaemia documented was unlikely to be the primary cause of asystole but may have been a contributing factor. It is hypothesised that a trigeminocardiac reflex was the primary contributory factor to asystole in the described case, and may represent a maxillomandibulocardiac reflex that has not been previously described in the horse.
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Affiliation(s)
- Aoife Ryan
- University of Veterinary Medicine, Vienna, Austria.,Anderson Moores Veterinary Specialists, Winchester, UK
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28
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Garrett C, Becker TM, Lynch D, Po J, Xuan W, Scott KF, de Souza P. Comparison of neutrophil to lymphocyte ratio and prognostic nutritional index with other clinical and molecular biomarkers for prediction of glioblastoma multiforme outcome. PLoS One 2021; 16:e0252614. [PMID: 34138894 PMCID: PMC8211244 DOI: 10.1371/journal.pone.0252614] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/19/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Pre- and post-operative neutrophil to lymphocyte ratio (NLR) and prognostic nutritional index (PNI) and other prognostic clinicopathological variables were correlated with progression free survival (PFS) and overall survival (OS) of Glioblastoma Multiforme (GBM) patients. Methods GBM patients (n = 87, single-centre, recruited 2013–2019) were retrospectively divided into low and high groups using literature-derived cut-offs (NLR = 5.07, PNI = 46.97). Kaplan-Meier survival curves and log rank tests assessed PFS and OS. Univariate and multivariate analyses identified PFS and OS prognosticators. Results High vs low post-operative PNI cohort was associated with longer PFS (279 vs 136 days, p = 0.009), but significance was lost on multivariate analysis. Post-operative ECOG (p = 0.043), daily dexamethasone (p = 0.023) and IDH mutation (p = 0.046) were significant on multivariate analysis for PFS. High pre- and post-operative PNI were associated with improved OS (384 vs 114 days, p = 0.034 and 516 vs 245 days, p = 0.001, respectively). Low postoperative NLR correlated with OS (408 vs 249 days, p = 0.029). On multivariate analysis using forward selection process, extent of resection (EOR) (GTR vs biopsy, p = 0.004 and STR vs biopsy, p = 0.011), and any previous surgery (p = 0.014) were independent prognostic biomarkers for OS. On multivariate analysis of these latter variables with literature-derived prognostic biomarkers, EOR remained significantly associated with OS (p = 0.037). Conclusions EOR, followed by having any surgery prior to GBM, are the most significant independent predictors of GBM patient’s OS. Post-operative ECOG, daily dexamethasone and IDH mutation are independent prognostic biomarkers for PFS. PNI may be superior to NLR. Post- vs pre-operative serum inflammatory marker levels may be associated with survival.
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Affiliation(s)
- Celine Garrett
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Circulating Tumour Cells Group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- * E-mail:
| | - Therese M. Becker
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Circulating Tumour Cells Group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- School of Medicine, University of New South Wales, Kingsford, NSW, Australia
| | - David Lynch
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Circulating Tumour Cells Group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Joseph Po
- Circulating Tumour Cells Group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Wei Xuan
- Circulating Tumour Cells Group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Kieran F. Scott
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Circulating Tumour Cells Group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Paul de Souza
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Circulating Tumour Cells Group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- School of Medicine, University of New South Wales, Kingsford, NSW, Australia
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
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29
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Restoring VTA DA neurons excitability accelerates emergence from sevoflurane general anesthesia of anxiety state. Biochem Biophys Res Commun 2021; 565:21-28. [PMID: 34090206 DOI: 10.1016/j.bbrc.2021.05.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/21/2021] [Indexed: 11/22/2022]
Abstract
Preoperative anxiety is common and often comes with a higher probability of worse recovery. However, the neurological mechanism of the effect of preoperative anxiety on general anesthesia and subsequent awakening remains unknown. In this study, we report an anxious state results in delayed awakening in anxiety model mice from sevoflurane general anesthesia. More profound inhibition of DA neurons in the VTA contributes to delayed awakening. Optogenetic stimulation of VTA DA neurons can reverse the delay. The results indicate that VTA DA neurons may be involved in the delay in awakening from general anesthesia caused by anxiety.
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30
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Koren SF, Engel LE, Møller MP. Preoperative psychogenic fever: to operate or not to operate. J Surg Case Rep 2021; 2021:rjab114. [PMID: 33815760 PMCID: PMC8007217 DOI: 10.1093/jscr/rjab114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/08/2021] [Indexed: 11/18/2022] Open
Abstract
Postponing elective surgery because of fever on the morning of the operation is frustrating for patients as well as doctors. It is also not cost effective and the unused operation capacity could have been used on other patients. On the other hand, surgery and general anaesthesia will put unwanted physiological strain on a patient fighting an on-going infection. Preoperative fever therefore poses a dilemma; to proceed with-, or to postpone the scheduled operation. We report a case where a 58-year-old woman, scheduled for prophylactic bilateral mastectomy and primary implant-based reconstruction, was postponed because of a temperature of 37.9°C. The morning of her new operation date, she developed a fever of 39.2°C which fell to 38.2°C shortly after administration of 0.25 mg triazolam. She was diagnosed with psychogenic fever, and we went through with the operation, even though the patient was febrile. The operation was successful, and she had no post-operative complications.
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Affiliation(s)
- Sondre F Koren
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Copenhagen University, Herlev, Denmark
| | - Lilan E Engel
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Copenhagen University, Herlev, Denmark
| | - Michael P Møller
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Copenhagen University, Herlev, Denmark
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31
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Koyuncu A, Yava A, Yamak B, Orhan N. Effect of family presence on stress response after bypass surgery. Heart Lung 2020; 50:193-201. [PMID: 33278754 DOI: 10.1016/j.hrtlng.2020.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) is a major surgery that may cause severe surgical stress response (SR). Although the presence of family members in intensive care unit (ICU) is known to benefit intensive care patients socially and emotionally, its effects on surgical SR are unknown. OBJECTIVES To investigate the effect of an informed family member (IFM)'s presence in the awakening process in ICU on patients' SR after CABG. METHODS A nonrandomized controlled clinical study was completed with a total of 73 patients: 37 patients in the control (CG) and 36 in the intervention group (IG) underwent CABG surgery. In the CG patients, no family members were taken into the ICU during the awakening process and routine care and treatment practices were continued. In the IG patients, besides routine care and treatment practices, an IFM was taken into the ICU during the awakening process in accordance with the research method. Groups were statistically compared in terms of serum cortisol level which is the one of the main indicators of surgical SR, state anxiety, sedative drug requirements, and duration of intubation, sedation, and ICU stay. A p value <0.05 was accepted as statistically significant. RESULTS Presence of an IFM in the ICU was found to be effective in decreasing serum cortisol level, state anxiety, sedative drug requirements, and the duration of intubation, sedation, and ICU stay (p<0.05). CONCLUSIONS In CABG, the presence of IFM in ICU is effective in reducing SR.
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Affiliation(s)
- Aynur Koyuncu
- Nursing Department, Hasan Kalyoncu University, Faculty of Health Sciences, Gaziantep, Turkey.
| | - Ayla Yava
- Nursing Department, Hasan Kalyoncu University, Faculty of Health Sciences, Gaziantep, Turkey.
| | - Birol Yamak
- Gaziantep Medikal Park Hospital, Gaziantep, Turkey.
| | - Nuri Orhan
- Gaziantep Medikal Park Hospital, Gaziantep, Turkey.
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Cusack B, Buggy D. Anaesthesia, analgesia, and the surgical stress response. BJA Educ 2020; 20:321-328. [PMID: 33456967 PMCID: PMC7807970 DOI: 10.1016/j.bjae.2020.04.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- B. Cusack
- Mater University Hospital, University College Dublin, Ireland
| | - D.J. Buggy
- Mater University Hospital, University College Dublin, Ireland
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Fan X, Wang D, Chen X, Wang R. Effects of Anesthesia on Postoperative Recurrence and Metastasis of Malignant Tumors. Cancer Manag Res 2020; 12:7619-7633. [PMID: 32922072 PMCID: PMC7457832 DOI: 10.2147/cmar.s265529] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/04/2020] [Indexed: 01/17/2023] Open
Abstract
It is difficult to control the recurrence and metastasis of malignant tumors; furthermore, anesthesia is considered one of the main influencing factors. There has been increasing clinical attention on the effects of anesthetic drugs and methods on postoperative tumor growth and metastasis. We reviewed the effects of anesthesia on tumor recurrence and metastasis; specifically, the effects of anesthetic agents, anesthesia methods, and related factors during the perioperative period on the tumor growth and metastasis were analyzed. This study can provide reference standards for rational anesthesia formulations and cancer-related pain analgesia protocols for surgical procedures in patients with malignant tumors. Moreover, it contributes toward an experimental basis for the improvement and development of novel anesthetic agents and methods.
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Affiliation(s)
- Xiaoqing Fan
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, Anhui 230001, People's Republic of China.,Department of Anesthesiology, Anhui Provincial Hospital, Hefei 230001, Anhui, People's Republic of China
| | - Delong Wang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, Anhui 230001, People's Republic of China.,Department of Anesthesiology, Anhui Provincial Hospital, Hefei 230001, Anhui, People's Republic of China
| | - Xueran Chen
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, Anhui 230031, People's Republic of China.,Department of Molecular Pathology, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, Anhui 230031, People's Republic of China
| | - Ruiting Wang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, Anhui 230001, People's Republic of China.,Department of Anesthesiology, Anhui Provincial Hospital, Hefei 230001, Anhui, People's Republic of China
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Zhang W, Cong X, Zhang L, Sun M, Li B, Geng H, Gu J, Zhang J. Effects of thoracic nerve block on perioperative lung injury, immune function, and recovery after thoracic surgery. Clin Transl Med 2020; 10:e38. [PMID: 32639645 PMCID: PMC7418816 DOI: 10.1002/ctm2.38] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/26/2020] [Accepted: 04/26/2020] [Indexed: 12/16/2022] Open
Abstract
Background To investigate the effects of thoracic nerve block on perioperative lung injury, immune function, and recovery after thoracic surgery Methods A total of 120 patients with lung cancer were randomly allocated into three groups: general anesthesia group (GAL group), thoracic paravertebral nerve block (TPVB) combined with general anesthesia (TPL group), and TPVB (with paravertebral dexmedetomidine) combined with general anesthesia group (TDL group); 120 patients with esophageal cancer were randomly allocated into three groups: general anesthesia group (GAE group), TPVB combined with general anesthesia group (TPE group), and thoracic epidural block combined with general anesthesia group (TEE group). Lung injury and immune function were evaluated. Hemodynamic changes, early recovery in post‐anesthesia care unit, pain, 6‐min walking test (6MWT), drug consumption, and life quality were also observed. The duration in the PACU of patients was retrospectively analyzed. The effect of dexmedetomidine on lung injury was established in vitro. Results The lung injury, including injury scores, apoptosis, and inflammation, were decreased in the TDL group compared with the GAL group and TPL group. The ratio of CD4+/CD8+ cells at the end of surgery was higher in the TPE group than in the GAE group. More stable hemodynamic was found in TPL group and TPE group. Acute pain was alleviated and the 6MWT was enhanced by TPVB with or without dexmedetomidine. Anesthetic consumption was decreased by thoracic nerve block. Conclusions Thoracic nerve block, especially TPVB with or without paravertebral dexmedetomidine, can enhance recovery after thoracic surgery. Protection against independent lung injury and cellular immune dysfunction may be a potential mechanism.
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Affiliation(s)
- Wei Zhang
- Department of Anesthesiology and Perioperative Medicine, Center for Clinical Single Cell Biomedicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Xuhui Cong
- Department of Anesthesiology and Perioperative Medicine, Center for Clinical Single Cell Biomedicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Liyuan Zhang
- Department of Anesthesiology and Perioperative Medicine, Center for Clinical Single Cell Biomedicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Mingyang Sun
- Department of Anesthesiology and Perioperative Medicine, Center for Clinical Single Cell Biomedicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Bing Li
- Department of Anesthesiology and Perioperative Medicine, Center for Clinical Single Cell Biomedicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Hongfang Geng
- Department of Anesthesiology and Perioperative Medicine, Center for Clinical Single Cell Biomedicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Jianqin Gu
- Department of General Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Center for Clinical Single Cell Biomedicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
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Wan Z, Chu C, Zhou R, Que B. Effects of Oxycodone Combined With Flurbiprofen Axetil on Postoperative Analgesia and Immune Function in Patients Undergoing Radical Resection of Colorectal Cancer. Clin Pharmacol Drug Dev 2020; 10:251-259. [PMID: 32567233 DOI: 10.1002/cpdd.818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/23/2020] [Indexed: 01/15/2023]
Abstract
The influence of surgery and anesthesia on immune function during the perioperative period should not be neglected. In this study, we evaluated the effects of oxycodone combined with flurbiprofen axetil on postoperative analgesia and immune function in patients undergoing radical resection of colorectal cancer (CRC). One hundred and thirty-three were randomized into the oxycodone combined with flurbiprofen axetil (OF) group or the sufentanil combined with flurbiprofen axetil (SF) group. Patients in the OF group were prescribed oxycodone hydrochloride 0.1 mg/kg combined with flurbiprofen axetil 3 mg/kg for postoperative analgesia, whereas the SF group received sufentanil 0.1 μg/kg combined with flurbiprofen axetil 3 mg/kg. The primary outcome was visual analog scale (VAS) score. Secondary outcomes included the quantities of CD4+ , CD8+ , and natural killer (NK) T cells, tumor necrosis factor (TNF)-α level, and interleukin (IL)-6 in peripheral blood, the consumption of analgesics, and the incidence of adverse reactions, and so forth. The VAS scores at rest were similar in both group. However, the VAS scores at cough in the OF group at 8, 12, and 24 hours postsurgery were lower than those in the SF group. Compared with the SF group, the count of CD4+ T cells and ratio of CD4+ /CD8+ were higher in the OF group at 12, 24, 48, and 72 hours postsurgery, although the count of CD8+ and NK T cells was higher than that in the SF group at 48 and 72 hours postsurgery. In addition, the serum level of TNF-α and IL-6 at 12, 24, 48, and 72 hours postsurgery in the OF group was lower than that in the SF group. In addition, the incidence of postoperative nausea, postoperative vomiting, and pruritus was lower, the time to first flatus and bowel movement was earlier in the OF group. Oxycodone combined with flurbiprofen axetil applied for patient-controlled intravenous analgesia could effectively reduce pain intensity, particularly for visceral pain, and help to reverse the status of immunosuppression during radical resection of CRC.
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MESH Headings
- Administration, Intravenous
- Aged
- Analgesia, Patient-Controlled/adverse effects
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/adverse effects
- Analgesics, Opioid/pharmacology
- Analgesics, Opioid/therapeutic use
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Anti-Inflammatory Agents, Non-Steroidal/adverse effects
- Anti-Inflammatory Agents, Non-Steroidal/pharmacology
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Case-Control Studies
- Colorectal Neoplasms/complications
- Colorectal Neoplasms/surgery
- Cytokines/analysis
- Cytokines/drug effects
- Drug Therapy, Combination/adverse effects
- Drug Therapy, Combination/methods
- Female
- Flurbiprofen/administration & dosage
- Flurbiprofen/adverse effects
- Flurbiprofen/analogs & derivatives
- Flurbiprofen/pharmacology
- Flurbiprofen/therapeutic use
- Humans
- Immunity/drug effects
- Immunity/immunology
- Middle Aged
- Outcome Assessment, Health Care
- Oxycodone/administration & dosage
- Oxycodone/adverse effects
- Oxycodone/pharmacology
- Oxycodone/therapeutic use
- Pain Measurement/drug effects
- Pain, Postoperative/drug therapy
- Pregnancy
- Sufentanil/administration & dosage
- Sufentanil/adverse effects
- Sufentanil/pharmacology
- Sufentanil/therapeutic use
- Visual Analog Scale
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Affiliation(s)
- Zhengzuo Wan
- Department of Anesthesiology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Chunhua Chu
- Department of Acupuncture and Massage, Zhejiang Provincial People's Hospital, Hangzhou, China
- Department of Acupuncture and Massage, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Rong Zhou
- Department of Anesthesiology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Bin Que
- Department of Anesthesiology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
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Awake Sedation With Propofol Attenuates Intraoperative Stress of Carotid Endarterectomy in Regional Anesthesia. Ann Vasc Surg 2020; 63:311-318. [DOI: 10.1016/j.avsg.2019.06.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 06/28/2019] [Accepted: 06/29/2019] [Indexed: 12/21/2022]
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Chi YL, Zhang WL, Yang F, Su F, Zhou YK. Transcutaneous Electrical Acupoint Stimulation for Improving Postoperative Recovery, Reducing Stress and Inflammatory Responses in Elderly Patient Undergoing Knee Surgery. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2019; 47:1445-1458. [PMID: 31752522 DOI: 10.1142/s0192415x19500745] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Transcutaneous electrical acupoint stimulation (TEAS) is a form of acupuncture treatment that applies electrical stimulation on specific acupoint through cutaneous electrodes. This technique has been used for perioperative anesthesia management as part of after surgery recovery. However, to date, limited data are available for using the TEAS for postoperative recovery in elderly surgical patients. We conducted this prospective randomized sham-control trail to evaluate the efficacy of TEAS in a group of elderly patients receiving knee surgery under epidural anesthesia. 52 subjects were assigned to either the experimental group (Group E) or control group (Group C). The patients in Group E received TEAS at zusanli (ST36), sanyinjiao (SP6), neiguan (PC6), and quchi acupoints (LI11) 30[Formula: see text]min prior to the epidural anesthesia and postoperative day 1 and 2, while patients in Group C received sham TEAS on the same acupoints for 30[Formula: see text]min same as those of Group E. The primary endpoint was the Quality of Recovery-40 questionnaire (QR-40) and the secondary endpoints were the biomarkers level of stress and inflammatory responses and visual analogue scale (VAS). A one-way ANOVA (SNK method) was used in statistic, and [Formula: see text] is considered to be statistically significant. Our data showed that the QoR-40 was significantly lower in Group C than that in Group E at postoperative day 1 ([Formula: see text]); Similarly, Cortisol (COR), Adrenocorticotropic Hormone (ACTH), and C-reactive protein (CRP) were significantly lower in Group E than those of Group C at postoperative day 1, 3, and 7 ([Formula: see text]), while the neutrophil/lymphocyte ratio (N/L) was lower in Group E than that in Group C at postoperative day 1 and 3 ([Formula: see text]). Our results showed that perioperative TEAS administration is able to facilitate the development of postoperative recovery of elderly patients, especially at the early stage after surgery. The reported results are likely to be mediated by the reduction of surgical inflammation and perioperative stress response.
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Affiliation(s)
- Yong-Liang Chi
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, P. R. China
- Department of Anesthesiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong 250014, P. R. China
| | - Wei-Liang Zhang
- Department of Anesthesiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong 250014, P. R. China
| | - Fan Yang
- Department of Anesthesiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong 250014, P. R. China
| | - Fan Su
- Department of Anesthesiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong 250014, P. R. China
| | - Yong-Kun Zhou
- Department of General Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong 250014, P. R. China
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Zhang H, Du G, Liu YF, Yang JH, A-Niu MG, Zhai XY, Jin B. Overlay of a sponge soaked with ropivacaine and multisite infiltration analgesia result in faster recovery after laparoscopic hepatectomy. World J Gastroenterol 2019; 25:5185-5196. [PMID: 31558866 PMCID: PMC6747283 DOI: 10.3748/wjg.v25.i34.5185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/04/2019] [Accepted: 08/19/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Compared with traditional open surgery, laparoscopic surgery is preferred due to the advantages of less trauma, less pain, and faster recovery. Nevertheless, many patients still suffer from postoperative pain resulting from the surgical incision and associated tissue injury. Many researchers have reported methods to improve postoperative pain control, but there is not a simple and effective method that can be clinically adopted in a widespread manner. We designed this study to prove the hypothesis that application of ropivacaine in the port site and operative site in patients is an effective and convenient method which can decrease postoperative pain and accelerate recovery.
AIM To evaluate the effects of ropivacaine on pain control after laparoscopic hepatectomy and its contribution to patient recovery.
METHODS From May 2017 to November 2018, 146 patients undergoing laparoscopic hepatectomy were randomized to receive infiltration of either 7.5 mg/mL ropivacaine around the trocar insertions, incision, and cutting surface of the liver (with a gelatin sponge soaked with ropivacaine) at the end of surgery (ropivacaine group), or normal saline (5 mL) at the same sites at the end of surgery (control group). The degree of pain, nausea, vomiting, heart rate (HR), and blood pressure were collected. The length of postoperative hospitalization, complications, and the levels of stress hormones were also compared between the two groups.
RESULTS Compared with the control group, the ropivacaine group showed reduced postoperative pain at rest within 12 h (P < 0.05), and pain on movement was reduced within 48 h. The levels of epinephrine, norepinephrine, and cortisol at 24 and 48 h, HR, blood pressure, and cumulative sufentanil consumption in the ropivacaine group were significantly lower than those in the control group (P < 0.05). In the ropivacaine group, hospitalization after operation was shorter, but the difference was not statistically significant. There were no significant differences in postoperative nausea, vomiting, or other complications, including hydrothorax, ascites, peritonitis, flatulence, and venous thrombus (P > 0.05), although fewer patients in the ropivacaine group experienced these situations.
CONCLUSION Infiltration with ropivacaine in the abdominal wound and covering the cutting surface of the liver with a gelatin sponge soaked with ropivacaine significantly reduce postoperative pain and the consumption of sufentanil.
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Affiliation(s)
- Hao Zhang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Gang Du
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Yan-Feng Liu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Jin-Huan Yang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Mu-Guo A-Niu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Xiang-Yu Zhai
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Bin Jin
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
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Ezhevskaya AA, Ovechkin AM, Prusakova ZB, Zagrekov VI, Mlyavykh SG, Anderson DG. Relationship among anesthesia technique, surgical stress, and cognitive dysfunction following spinal surgery: a randomized trial. J Neurosurg Spine 2019; 31:894-901. [PMID: 31491757 DOI: 10.3171/2019.4.spine184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/19/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical trauma is known to result in systemic inflammatory changes that can lead to postoperative cognitive dysfunction. In the present study, the authors compared the effects of an epidural anesthesia protocol to those of traditional anesthesia with regard to postoperative inflammatory changes, cellular immunity, and cognitive dysfunction. METHODS Forty-eight patients, ages 45-60 years, underwent multilevel thoracolumbar decompression and fusion and were randomly assigned to one of two groups: group 1 (27 patients) had combined epidural and general anesthesia, followed by epidural analgesia for 48 hours after surgery, and group 2 (21 patients) had general anesthesia, followed by traditional opioid pain management after surgery. At multiple time points, data on pain control, cognitive function, cellular immunity, and inflammatory markers were collected. RESULTS Group 1 patients demonstrated lower pain levels, less systemic inflammation, less cellular immune dysfunction, and less postoperative cognitive dysfunction than group 2 patients. CONCLUSIONS The use of combined epidural and general anesthesia followed by postoperative epidural analgesia during the first 48 hours after multilevel thoracolumbar decompression and fusion surgery had a significant positive effect on pain management, cellular immune function, systemic inflammation, and postoperative cognitive function.Clinical trial registration no.: 115080510080 (http://rosrid.ru).
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Affiliation(s)
- Anna A Ezhevskaya
- 1Federal State Budgetary Educational Institution of Higher Education Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhniy Novgorod, Russian Federation
| | - Alexei M Ovechkin
- 2I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation; and
| | - Zhanna B Prusakova
- 1Federal State Budgetary Educational Institution of Higher Education Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhniy Novgorod, Russian Federation
| | - Valery I Zagrekov
- 1Federal State Budgetary Educational Institution of Higher Education Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhniy Novgorod, Russian Federation
| | - Sergey G Mlyavykh
- 1Federal State Budgetary Educational Institution of Higher Education Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhniy Novgorod, Russian Federation
| | - D Greg Anderson
- 3Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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A Retrospective Observational Study of the Neuroendocrine Stress Response in Patients Undergoing Endoscopic Transsphenoidal Surgery for Removal of Pituitary Adenomas: Total Intravenous Versus Balanced Anesthesia. J Neurosurg Anesthesiol 2019; 33:137-146. [PMID: 31453876 DOI: 10.1097/ana.0000000000000638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/16/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Anesthetic technique affects the neuroendocrine stress response to surgery. In this retrospective study, we compared the neuroendocrine stress response in patients undergoing endoscopic transsphenoidal pituitary adenoma surgery (ETSPAS) with total intravenous anesthesia (TIVA) with propofol-remifentanil or balanced anesthesia (BAL) with sevoflurane-remifentanil. MATERIALS AND METHODS Eighty-nine patients undergoing ETSPAS were anesthetized with either propofol-remifentanil (TIVA group, n=62) or sevoflurane-remifentanil (BAL group, n=27). Data were retrospectively collected regarding preoperative and immediate postoperative serum levels of adrenocorticotropic hormone (ACTH) and cortisol (primary outcome measures), as well as other pituitary hormones and their target organ hormones (secondary outcome measures). RESULTS There were no significant differences in preoperative pituitary hormone levels between the 2 groups. The immediate postoperative ACTH (89.5 [62.1 to 162.6] vs. 256.0 [92.0 to 570.7] pg/mL; P<0.001) level was lower in the TIVA group than in the BAL group, whereas immediate postoperative cortisol levels were similar between the 2 groups. The immediate postoperative thyroid-stimulating hormone (1.85 [1.21 to 2.98] vs. 1.21 [0.44 to 1.71] μIU/mL; P=0.003), triiodothyronine (91.0 [82.0 to 103.0] vs. 69.1 [64.6 to 76.2] ng/dL; P<0.001), luteinizing hormone (2.2 [1.2 to 4.0] vs. 1.0 [0.5 to 2.3] mIU/mL; P=0.005), and prolactin (22.6±15.8 vs. 12.8±10.2 ng/mL; P=0.005) levels were higher in the TIVA group compared with the BAL group. In both groups, none of the patients who had sufficient preoperative ACTH without hydrocortisone supplementation (n=15) showed hypocortisolism in the immediate postoperative measurement. CONCLUSIONS Compared with BAL, TIVA resulted in reduced release of ACTH and increased release of thyroid-stimulating hormone, triiodothyronine, luteinizing hormone, and prolactin in patients undergoing ETSPAS.
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Moyano J, Aguirre L. Opioids in the immune system: from experimental studies to clinical practice. ACTA ACUST UNITED AC 2019; 65:262-269. [PMID: 30892453 DOI: 10.1590/1806-9282.65.2.262] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 08/27/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Opioids interact with both innate and adaptive immune systems and have direct effects on opioid receptors located on immune cells. Research on this topic has provided evidence of the opioid influence on the immune response associated with surgical stress. The immunological effects of opioids are currently being investigated, particularly whether they influence the outcome of surgery or the underlying disease regarding important aspects like infection or cancer progression. This review addresses background research related to the influence of the opioid receptor on the immune system, the immunosuppressive effect associated with major opioids during the perioperative period, and their clinical relevance. The objective of the study was to review the effects of opioids on the immune system.
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Affiliation(s)
- Jairo Moyano
- Anesthesia Department, Pain Service, Hospital Universitario Fundación Santafé de Bogotá, Bogotá, Colombia
| | - Luisa Aguirre
- Anesthesia Department, Pain Service, Hospital Universitario Fundación Santafé de Bogotá, Bogotá, Colombia
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Wang L, Holland L, Fong R, Khokhar S, Fox AP, Xie Z. A pilot study showing that repeated exposure to stress produces alterations in subsequent responses to anesthetics in rats. PLoS One 2019; 14:e0214093. [PMID: 30908509 PMCID: PMC6433219 DOI: 10.1371/journal.pone.0214093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/06/2019] [Indexed: 12/11/2022] Open
Abstract
The repeated use of a drug frequently leads to alterations in the response to that drug. We undertook this study to determine whether multiple exposures to the general anesthetic produced alterations in subsequent exposures to this anesthetic. For this study, adult male rats were anesthetized with 2.5% isoflurane for one hour. The rats were divided into 4 groups of 8 rats each. Groups 1-3 were transported between their homeroom and the anesthesia testing room and were handled in an identical manner weekly for a period of 12 weeks, but were anesthetized on different schedules. Group 1 was anesthetized weekly for 12 weeks, Group 2 on either a 3 or 4 week schedule and Group 3 was anesthetized a single time, at the end of the 12 week period. To receive anesthesia multiple times, animals were transported from their homeroom to the anesthesia location and handled repeatedly. We took into consideration of the frequency of anesthesia exposure and the stress involved. Rats in groups 2 and 3 were placed in the anesthesia chamber, with O2 but with no anesthetic, every week when they were not scheduled to receive anesthesia. In Group 4, rats were not transported or handled in any way and stayed in the home room for a period of 12 weeks. Rats in this group were anesthetized once, at the very end of the study. Recovery of the rat's righting reflex was used to assess the acceleration of recovery time from general anesthesia. Group 1 rats showed dramatically faster emergence from anesthesia after several rounds of anesthesia. Surprisingly, Groups 2 and 3 rats, treated in an identical manner as Group 1, but which were anesthetized on different schedules, also exhibited more rapid emergence from anesthesia, when compared to Group 4 rats, which were never handled or transported prior to a single anesthesia. These results suggest that the stress of transportation and handling altered responsiveness to anesthesia. Our results show that responsiveness to anesthetic agents can change over time outside of the normal developmental changes taking place in rats as they age.
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Affiliation(s)
- Lingzhi Wang
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois, United States of America
- Department of Anesthesia, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, P. R. China
| | - Lindsay Holland
- University of Michigan, College of Medicine, Ann Arbor, Michigan, United States of America
| | - Robert Fong
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois, United States of America
| | - Suhail Khokhar
- University of Illinois at Chicago, College of Medicine, Chicago, Illinois, United States of America
| | - Aaron P. Fox
- Department of Neurobiology, Pharmacology and Physiology, The University of Chicago, Chicago, Illinois, United States of America
| | - Zheng Xie
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois, United States of America
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Quiram BJ, Crippa J, Grass F, Lovely JK, Behm KT, Colibaseanu DT, Merchea A, Kelley SR, Harmsen WS, Larson DW. Impact of enhanced recovery on oncological outcomes following minimally invasive surgery for rectal cancer. Br J Surg 2019; 106:922-929. [PMID: 30861099 DOI: 10.1002/bjs.11131] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/18/2018] [Accepted: 01/15/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Oncological outcomes of locally advanced rectal cancer depend on the quality of surgical and oncological management. Enhanced recovery pathways (ERPs) have yet to be assessed for their oncological impact when used in combination with minimally invasive surgery. This study assessed outcomes with or without an ERP in patients with rectal cancer. METHODS This was a retrospective analysis of all consecutive adult patients who underwent elective minimally invasive surgery for primary rectal adenocarcinoma with curative intent between February 2005 and April 2018. Both laparoscopic and robotic procedures were included. Short-term morbidity and overall survival were compared between patients treated according to the institutional ERP and those who received conventional care. RESULTS A total of 600 patients underwent minimally invasive surgery, of whom 320 (53·3 per cent) were treated according to the ERP and 280 (46·7 per cent) received conventional care. ERP was associated with less overall morbidity (34·7 versus 54·3 per cent; P < 0·001). Patients in the ERP group had improved overall survival on univariable (91·4 versus 81·7 per cent at 5 years; hazard ratio (HR) 0·53, 95 per cent c.i. 0·28 to 0·99) but not multivariable (HR 0·78, 0·41 to 1·50) analysis. Multivariable analysis revealed age (HR 1·46, 1·17 to 1·82), male sex (HR 1·98, 1·05 to 3·70) and complications (HR 2·23, 1·30 to 3·83) as independent risk factors for compromised overall survival. Disease-free survival was comparable for patients who had ERP or conventional treatment (80·5 versus 84·6 per cent at 5 years respectively; P = 0·272). CONCLUSION Treatment within an ERP was associated with a lower morbidity risk that may have had a subtle impact on overall but not disease-specific survival.
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Affiliation(s)
- B J Quiram
- St Olaf College, Northfield, Minnesota, USA
| | - J Crippa
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - F Grass
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - J K Lovely
- Mayo Clinic Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - K T Behm
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - D T Colibaseanu
- Mayo Clinic Pharmacy, Mayo Clinic, Rochester, Minnesota, USA.,Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - A Merchea
- Mayo Clinic Pharmacy, Mayo Clinic, Rochester, Minnesota, USA.,Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - S R Kelley
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - W S Harmsen
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - D W Larson
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Soliman S, Dehis M, Ahmed M, Kateeb EE. Assessment of Osteoimmunological Changes Following Orthognathic Surgery. Open Access Maced J Med Sci 2019; 7:632-636. [PMID: 30894927 PMCID: PMC6420938 DOI: 10.3889/oamjms.2019.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND There is a scarcity in the published literature which evaluates the postoperative inflammatory response and patients' immunity following orthognathic surgery. AIM The present prospective study aimed to evaluate the changes in two immunological callipers to measure the traumatic effect of orthognathic surgery. METHODS In the present prospective cohort study, we included women (age range 16-30 years) with severe dentofacial deformities who were scheduled for bimaxillary osteotomy. Blood samples were collected for measurement of transforming growth factor beta one (TGF-β1) and osteoprotegrin (OPG) levels. The statistical analysis was carried with SPSS software. RESULTS In the present study, nine patients with severe dentofacial deformity were operated successfully under general anaesthesia. All patients reported decreased energy and fatigue in the early days after surgery and had difficulties with nutrition due to pain, oedema and paresthesia; however, no massive weight loss was reported. The levels of OPG started to increase immediately postoperatively (mean = 0.46 ± 0.08; p = 0.001). A significant increase in the concentration of OPG begun postoperatively and continued to rise significantly until the six weeks to reach 2.24 ± 0.30 ng/mL (p < 0.001). Similarly, the concentration of TGF-β1 increased at three days postoperatively and continued to rise until the six weeks to reach 1.28 ± 0.19 ng/mL (p <0 .001). CONCLUSION In conclusion, orthognathic surgery is associated with a significant rise in the pro-inflammatory cytokines until the six weeks postoperatively. These observed results may indicate a significant alteration in the immunity of the patients to undergoing orthognathic surgery.
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Affiliation(s)
- Sara Soliman
- Oral and Maxillofacial Surge, Pharos University in Alexandria, Alexandria, Egypt
| | - Mohammad Dehis
- Oral and Maxillofacial Surge, Pharos University in Alexandria, Alexandria, Egypt
| | - Mamdouh Ahmed
- Oral and Maxillofacial Surge, Pharos University in Alexandria, Alexandria, Egypt
| | - Engy El Kateeb
- Clinical Pathology Department, Pharos University in Alexandria, Alexandria, Egypt
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Kisani AI, Tughgba T, Elsa AT. Effects of various surgical procedures on biochemical parameters of Nigerian dogs and their clinical implications. Vet World 2018; 11:909-914. [PMID: 30147258 PMCID: PMC6097566 DOI: 10.14202/vetworld.2018.909-914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/21/2018] [Indexed: 12/05/2022] Open
Abstract
AIM The importance of physical and psychological stress caused by pain during surgery cannot be overemphasized. The aim of this study was to assess the effects of ovariohysterectomy (OVH), gastrotomy (GST), and intestinal resection and anastomosis (IRA) on biochemical parameters of Nigerian dogs anesthetized with the xylazine-propofol combination. MATERIALS AND METHODS A total of 12 dogs were randomly divided into three groups of four each. The animals were treated with xylazine and propofol anesthetics for OVH, GST, and IRA in Groups 1-3, respectively. Blood samples were collected at 0 h, 2, 24, 48, 72, 96, 120, and 144 h postsurgery for determination of cortisol (CORT), glucose (GLU), total protein (TP), albumin (ALB), globulin (GL), and ALB/GL ratio. RESULTS There were significant increases (p<0.05) in mean CORT concentrations 2 h postsurgery in the three groups and at 24 h in Group 3 and 96 h in Groups 1 and 3, respectively. GLU concentrations increased significantly (p<0.05) in the three groups at 2 h postsurgery. The mean protein concentrations in Groups 2 and 3 decreased significantly (p<0.05) at 2h and 24 h and 72 h, 96 h, 120 h, and 144 h in Group 3, respectively. There was significant decrease (p<0.05) in the mean ALB concentrations at 2 h, 24 h, 72 h, 96 h, 120 h, and 144 h postsurgery. There was a significant difference (p<0.05) in the mean GL concentrations in Group 3 at 24 h, 72 h, 96 h, and 144 h. All other parameters were not significantly different (p>0.05) in comparison with the control. CONCLUSION Xylazine-propofol combination could decrease humoral immune status and increase serum GLU level invariably portending a high risk of diabetes in the vulnerable dogs.
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Affiliation(s)
- Aboh Iku Kisani
- Department of Veterinary Surgery and Theriogenology, College of Veterinary Medicine, Federal University of Agriculture, P.M.B. 2373, Makurdi, Benue State, Nigeria
| | - Terzungwe Tughgba
- Department of Veterinary Surgery and Theriogenology, College of Veterinary Medicine, Federal University of Agriculture, P.M.B. 2373, Makurdi, Benue State, Nigeria
| | - Abdullahi Teleh Elsa
- Department of Veterinary Surgery and Theriogenology, College of Veterinary Medicine, Federal University of Agriculture, P.M.B. 2373, Makurdi, Benue State, Nigeria
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Poredos P, Mavric A, Leben L, Poredos P, Jezovnik MK. Total Hip Replacement Provokes Endothelial Dysfunction. Angiology 2018; 69:871-877. [DOI: 10.1177/0003319718774660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Surgery represents an increased risk of different perioperative complications. Endothelial function (EF) is a key mechanism responsible for cardiovascular homeostasis and is involved in thromboembolic complications. We aimed to follow changes of EF in an early postoperative period in patients undergoing total hip replacement (THR). Endothelial function was assessed noninvasively in 70 consecutive patients who underwent an elective THR under spinal anesthesia. Flow-mediated dilation (FMD) and low flow-mediated constriction capability of the brachial artery, which are indicators of EF were measured before the operation (baseline), 24 hours after the operative procedure, and 5 to 7 days postoperatively. Baseline FMD was 12.3% and decreased a day after surgery to 7.3% ( P < .001). After 5 to 7 days, it gradually increased to 9.2%. However, on average, it was lower than before surgery ( P < .001). The median duration of THR was 85.0 (65.0-100.0) minutes, the average hospital length of stay was 7 days. Total hip replacement is associated with an immediate decrease in FMD which remains significantly decreased 5 to 7 days after the surgery compared with the preoperative value. These results indicate that surgery provokes endothelial dysfunction and deteriorates cardiovascular homeostasis. This effect could be involved in cardiovascular complications in the postoperative period.
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Affiliation(s)
- Peter Poredos
- Department of Anaesthesiology and Perioperative Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ana Mavric
- Department of Vascular Disease, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Lara Leben
- Department of Vascular Disease, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Pavel Poredos
- Department of Vascular Disease, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mateja Kaja Jezovnik
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, USA
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Kahloul M, Mhamdi S, Nakhli MS, Sfeyhi AN, Azzaza M, Chaouch A, Naija W. Effects of music therapy under general anesthesia in patients undergoing abdominal surgery. Libyan J Med 2018; 12:1260886. [PMID: 28452603 PMCID: PMC5328375 DOI: 10.1080/19932820.2017.1260886] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Music therapy, an innovative approach that has proven effectiveness in many medical conditions, seems beneficial also in managing surgical patients. The aim of this study is to evaluate its effects, under general anesthesia, on perioperative patient satisfaction, stress, pain, and awareness. METHODS This is a prospective, randomized, double-blind study conducted in the operating theatre of visceral surgery at Sahloul Teaching Hospital over a period of 4 months. Patients aged more than 18 undergoing a scheduled surgery under general anesthesia were included. Patients undergoing urgent surgery or presenting hearing or cognitive disorders were excluded. Before induction, patients wore headphones linked to an MP3 player. They were randomly allocated into 2 groups: Group M (with music during surgery) and group C (without music). Hemodynamic parameters, quality of arousal, pain experienced, patient's satisfaction, and awareness incidence during anesthesia were recorded. RESULTS One hundred and forty patients were included and allocated into 2 groups that were comparable in demographic characteristics, surgical intervention type and anesthesia duration. Comparison of these two groups regarding the hemodynamic profile found more stability in group M for systolic arterial blood pressure. A calm recovery was more often noted in group M (77.1% versus 44%, p < 10-3). The average Visual Analog Scale (VAS) score was lower in the intervention group (33.8 ± 13.63 versus 45.1 ± 16.2; p < 10-3). The satisfaction rate was significantly higher among the experimental group (81.4% versus 51.4%; p < 10-3). The incidence of intraoperative awareness was higher in group C (8 cases versus 3 cases) but the difference was not statistically significant. CONCLUSION Music therapy is a non-pharmacological, inexpensive, and non-invasive technique that can significantly enhance patient satisfaction and decrease patients' embarrassing experiences related to perioperative stress, pain, and awareness.
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Affiliation(s)
- Mohamed Kahloul
- a Department of Anesthesia and Intensive Care, Teaching Hospital of Sahloul , University of Medicine Ibn Jazzar , Sousse , Tunisia
| | - Salah Mhamdi
- a Department of Anesthesia and Intensive Care, Teaching Hospital of Sahloul , University of Medicine Ibn Jazzar , Sousse , Tunisia
| | - Mohamed Said Nakhli
- a Department of Anesthesia and Intensive Care, Teaching Hospital of Sahloul , University of Medicine Ibn Jazzar , Sousse , Tunisia
| | - Ahmed Nadhir Sfeyhi
- a Department of Anesthesia and Intensive Care, Teaching Hospital of Sahloul , University of Medicine Ibn Jazzar , Sousse , Tunisia
| | - Mohamed Azzaza
- b Department of Abdominal Surgery, Teaching Hospital of Sahloul , University of Medicine Ibn Jazzar , Sousse , Tunisia
| | - Ajmi Chaouch
- a Department of Anesthesia and Intensive Care, Teaching Hospital of Sahloul , University of Medicine Ibn Jazzar , Sousse , Tunisia
| | - Walid Naija
- a Department of Anesthesia and Intensive Care, Teaching Hospital of Sahloul , University of Medicine Ibn Jazzar , Sousse , Tunisia
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Selvam V, Subramaniam R, Baidya DK, Chhabra A, Gupta N, Dadhwal V, Malhotra N. Safety and Efficacy of Low-Dose Intrathecal Morphine for Laparoscopic Hysterectomy: A Randomized, Controlled Pilot Study. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Velmurugan Selvam
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeshwari Subramaniam
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Dalim Kumar Baidya
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Anjolie Chhabra
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Nandita Gupta
- Department of Endocrinology, Metabolism and Diabetes, All India Institute of Medical Sciences, New Delhi, India
| | - Vatsla Dadhwal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Sun JX, Bai KY, Liu YF, Du G, Fu ZH, Zhang H, Yang JH, Wang B, Wang XY, Jin B. Effect of local wound infiltration with ropivacaine on postoperative pain relief and stress response reduction after open hepatectomy. World J Gastroenterol 2017; 23:6733-6740. [PMID: 29085218 PMCID: PMC5643294 DOI: 10.3748/wjg.v23.i36.6733] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/17/2017] [Accepted: 08/25/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To prospectively evaluate the effect of local wound infiltration with ropivacaine on postoperative pain relief and stress response reduction after open hepatectomy.
METHODS A total of 56 patients undergoing open hepatectomy were randomly divided into two groups: a ropivacaine group (wound infiltration with ropivacaine solution) and a control group (infiltration with isotonic saline solution). A visual analog scale (VAS) at rest and on movement was used to measure postoperative pain for the first 48 h after surgery. Mean arterial pressure (MAP), heart rate (HR), time to bowel recovery, length of hospitalization after surgery, cumulative sufentanil consumption, and incidence of nausea and vomiting were compared between the two groups. Surgical stress hormones (epinephrine, norepinephrine, and cortisol) were detected using enzyme-linked immunosorbent assay, and the results were compared.
RESULTS VAS scores both at rest and on movement at 24 h and 48 h were similar between the two groups. Significantly lower VAS scores were detected at 0, 6, and 12 h in the ropivacaine group compared with the control group (P < 0.05 for all). MAP was significantly lower at 6, 12, and 24 h (P < 0.05 for all); HR was significantly lower at 0, 6, 12, and 24 h (P < 0.05 for all); time to bowel recovery and length of hospitalization after surgery (P < 0.05 for both) were significantly shortened; and cumulative sufentanil consumption was significantly lower at 6, 12, 24, and 36 h (P < 0.05 for all) in the ropivacaine group than in the control group, although the incidence of nausea and vomiting showed no significant difference between the two groups. The levels of epinephrine, norepinephrine, and cortisol were significantly lower in the ropivacaine group than in the control group at 24 and 48 h (P < 0.01 for all).
CONCLUSION Local wound infiltration with ropivacaine after open hepatectomy can improve postoperative pain relief, reduce surgical stress response, and accelerate postoperative recovery.
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Affiliation(s)
- Jing-Xian Sun
- Department of Anorectal Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250011, Shandong Province, China
| | - Ke-Yun Bai
- Department of Anorectal Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250011, Shandong Province, China
| | - Yan-Feng Liu
- Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Gang Du
- Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Zhi-Hao Fu
- Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Hao Zhang
- Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Jin-Huan Yang
- Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Ben Wang
- Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Xiu-Yu Wang
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Bin Jin
- Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
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Hu N, Wang C, Zheng Y, Ao J, Zhang C, Xie K, Li Y, Wang H, Yu Y, Wang G. The role of the Wnt/β-catenin-Annexin A1 pathway in the process of sevoflurane-induced cognitive dysfunction. J Neurochem 2016; 137:240-52. [PMID: 26851642 DOI: 10.1111/jnc.13569] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 01/18/2016] [Accepted: 01/25/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Nan Hu
- Department of Anesthesiology; Tianjin Medical University General Hospital; Tianjin China
- Tianjin Research Institute of Anesthesiology; Tianjin China
| | - Chao Wang
- Department of Anesthesiology; Tianjin Medical University General Hospital; Tianjin China
- Tianjin Research Institute of Anesthesiology; Tianjin China
| | - Yuxin Zheng
- Department of Anesthesiology; Tianjin Medical University General Hospital; Tianjin China
- Tianjin Research Institute of Anesthesiology; Tianjin China
| | - Jiying Ao
- Department of Anesthesiology; Tianjin Medical University General Hospital; Tianjin China
- Tianjin Research Institute of Anesthesiology; Tianjin China
| | - Chao Zhang
- Department of orthopedics; Tianjin Medical University General Hospital; Tianjin China
| | - Keliang Xie
- Department of Anesthesiology; Tianjin Medical University General Hospital; Tianjin China
- Tianjin Research Institute of Anesthesiology; Tianjin China
| | - Yize Li
- Department of Anesthesiology; Tianjin Medical University General Hospital; Tianjin China
- Tianjin Research Institute of Anesthesiology; Tianjin China
| | - Haiyun Wang
- Department of Anesthesiology; Tianjin the Third Central Hospital; Tianjin China
| | - Yonghao Yu
- Department of Anesthesiology; Tianjin Medical University General Hospital; Tianjin China
- Tianjin Research Institute of Anesthesiology; Tianjin China
| | - Guolin Wang
- Department of Anesthesiology; Tianjin Medical University General Hospital; Tianjin China
- Tianjin Research Institute of Anesthesiology; Tianjin China
- Department of Critical Care Medicine of Tianjin Medical University General Hospital; Tianjin China
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