scholarly journals Effects of Combined Epidural Anesthesia and General Anesthesia on Cognitive Function and Stress Responses of Elderly Patients Undergoing Liver Cancer Surgery

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Zhixiu Meng ◽  
Cao Gao ◽  
Xin Li ◽  
Jiang Shen ◽  
Tao Hong ◽  
...  
Keyword(s):  
Liver Cancer ◽  
Elderly Patients ◽  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Stress Responses ◽  
Adverse Reactions ◽  
Operating Time ◽  
Cancer Surgery ◽  
Joint Group ◽  
Total Fluid

This study aimed at exploring the effects of combined epidural anesthesia and general anesthesia on the cognitive function and stress responses of elderly patients undergoing liver cancer surgery. One hundred and fifteen elderly patients were enrolled as research subjects. They were admitted to our hospital and underwent liver cancer surgery from August 2017 to May 2019. Fifty five cases were treated with general anesthesia (GA) (GA group), while the other sixty cases were treated with combined epidural anesthesia and general anesthesia (joint group). Scoring standards of Mini-Mental State Examination (MMSE) were used to evaluate the patients before and after operation. Their operating time, total fluid input (TFI), spontaneous breathing recovery time (SBRT), preoperative and postoperative indices of stress responses (epinephrine (EPI), cortisol (Cor), and norepinephrine (NE)), and postoperative adverse reactions were observed. There were statistically significant differences between the two groups with respect to anesthesia time, TFI, postoperative SBRT, and postoperative directional recovery time (DRT) (c P < 0.05 ). There was no difference in operating time, total fluid loss (TFL), and hospitalization time ( P > 0.05 ). After operation, patients in both groups experienced a cognitive decline of different degrees and the MMSE scores decreased. There was no significant difference in the score between the two groups before operation and 3 days and 7 days after operation ( P > 0.05 ). The score was significantly better in the joint group than that in the GA group at 6 hours and 1 day after operation ( P < 0.05 ). There were no significant differences in levels of EPI, Cor, and NE between the two groups before operation ( P > 0.05 ), but there were significant differences after operation. The total incidence of postoperative adverse reactions was 11.67% in the joint group and 25.45% in the GA group. In conclusion, combined epidural anesthesia and general anesthesia can significantly reduce postoperative cognitive dysfunction and inhibit postoperative stress responses in elderly patients undergoing liver cancer surgery. It has good application value in clinical practice.

scholarly journals Epidural Anesthesia–Analgesia and Recurrence-free Survival after Lung Cancer Surgery: A Randomized Trial

2021 ◽  
Author(s):  
Zhen-Zhen Xu ◽  
Huai-Jin Li ◽  
Mu-Han Li ◽  
Si-Ming Huang ◽  
Xue Li ◽  
...  
Keyword(s):  
Lung Cancer ◽  
General Anesthesia ◽  
Survival Time ◽  
Epidural Anesthesia ◽  
Lung Cancer Surgery ◽  
Hazard Ratio ◽  
Cancer Surgery ◽  
Recurrence Free Survival ◽  
Cancer Specific Survival ◽  
Free Survival

Background Regional anesthesia and analgesia reduce the stress response to surgery and decrease the need for volatile anesthesia and opioids, thereby preserving cancer-specific immune defenses. This study therefore tested the primary hypothesis that combining epidural anesthesia–analgesia with general anesthesia improves recurrence-free survival after lung cancer surgery. Methods Adults scheduled for video-assisted thoracoscopic lung cancer resections were randomized 1:1 to general anesthesia and intravenous opioid analgesia or combined epidural–general anesthesia and epidural analgesia. The primary outcome was recurrence-free survival (time from surgery to the earliest date of recurrence/metastasis or all-cause death). Secondary outcomes included overall survival (time from surgery to all-cause death) and cancer-specific survival (time from surgery to cancer-specific death). Long-term outcome assessors were blinded to treatment. Results Between May 2015 and November 2017, 400 patients were enrolled and randomized to general anesthesia alone (n = 200) or combined epidural–general anesthesia (n = 200). All were included in the analysis. The median follow-up duration was 32 months (interquartile range, 24 to 48). Recurrence-free survival was similar in each group, with 54 events (27%) with general anesthesia alone versus 48 events (24%) with combined epidural–general anesthesia (adjusted hazard ratio, 0.90; 95% CI, 0.60 to 1.35; P = 0.608). Overall survival was also similar with 25 events (13%) versus 31 (16%; adjusted hazard ratio, 1.12; 95% CI, 0.64 to 1.96; P = 0.697). There was also no significant difference in cancer-specific survival with 24 events (12%) versus 29 (15%; adjusted hazard ratio, 1.08; 95% CI, 0.61 to 1.91; P = 0.802). Patients assigned to combined epidural–general had more intraoperative hypotension: 94 patients (47%) versus 121 (61%; relative risk, 1.29; 95% CI, 1.07 to 1.55; P = 0.007). Conclusions Epidural anesthesia–analgesia for major lung cancer surgery did not improve recurrence-free, overall, or cancer-specific survival compared with general anesthesia alone, although the CI included both substantial benefit and harm. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Comparison of general anesthesia with endotracheal intubation, combined spinal-epidural anesthesia, and general anesthesia with laryngeal mask airway and nerve block for intertrochanteric fracture surgeries in elderly patients: a retrospective cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yang Liu ◽  
Mang Su ◽  
Wei Li ◽  
Hao Yuan ◽  
Cheng Yang
Keyword(s):  
Elderly Patients ◽  
General Anesthesia ◽  
Nerve Block ◽  
Epidural Anesthesia ◽  
Intertrochanteric Fracture ◽  
Combined Spinal Epidural ◽  
Variation Rate ◽  
Vas Scores ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

Abstract Background There is no consensus on the optimal anesthesia method for intertrochanteric fracture surgeries in elderly patients. Our study aimed to compare the hemodynamics and perioperative outcomes of general anesthesia with endotracheal intubation, combined spinal-epidural anesthesia, and general anesthesia with laryngeal mask airway (LMA) and nerve block for intertrochanteric fracture surgeries in elderly patients. Methods This is a retrospective study of 75 patients aged > 60 years scheduled for intertrochanteric fracture surgeries with general anesthesia with intubation (n = 25), combined spinal-epidural anesthesia (n = 25), and general anesthesia with LMA and nerve block (n = 25). The intraoperative hemodynamics were recorded, and the maximum variation rate was calculated. Postoperative analgesic effect was evaluated using the visual analog scale (VAS). Postoperative cognitive status was assessed using the Mini-Mental State Exam (MMSE). Results The maximum variation rate of intraoperative heart rate, systolic blood pressure, diastolic blood pressure differed significantly between the three groups (general anesthesia with intubation > combined spinal-epidural anesthesia > general anesthesia with LMA and nerve block). The VAS scores postoperative 2 h, 4 h, 6 h, and 8 h also differed significantly between the three groups (general anesthesia with intubation > combined spinal-epidural anesthesia > general anesthesia with LMA and nerve block). The VAS scores postoperative 24 h were significantly lower in the general anesthesia with LMA/nerve block group than the general anesthesia with intubation group and the combined spinal-epidural anesthesia group. The MMSE scores postoperative 15 min and 45 min differed significantly between the three groups (general anesthesia with intubation < combined spinal-epidural anesthesia < general anesthesia with LMA and nerve block). The MMSE scores postoperative 120 min in the general anesthesia with intubation group were the lowest among the three groups. There was no significant difference in the incidence of respiratory infection postoperative 24 h, 48 h, and 72 h between the three groups. Conclusion Compared to general anesthesia with intubation and combined spinal-epidural anesthesia, general anesthesia with LMA and nerve block had better postoperative analgesic effect and less disturbances on intraoperative hemodynamics and postoperative cognition for elderly patients undergoing intertrochanteric fracture surgeries.

Perioperative epidural analgesia and recurrence-free survival for ovarian cancer surgery: A retrospective analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16534-e16534
Author(s):  
Dominique Koensgen ◽  
Alexander Mustea ◽  
Barbara Rosanowski ◽  
Bianca Leutzow ◽  
Thomas Hesse ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Cancer Recurrence ◽  
Cancer Surgery ◽  
Opioid Analgesia ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Group A ◽  
Group B

e16534 Background: Current experimental and clinical data suggest that perioperative factors may influence the long-term outcome after cancer surgery. Recent retrospective analyses have shown the reduction of cancer recurrence and metastatic spread in patients after tumor surgery receiving perioperative regional and neuraxial analgesia. The aim was to investigate whether perioperative epidural anesthesia is associated with the decreased disease recurrence and increased survival after primary tumor debulking in patients with ovarian cancer. Methods: Retrospective analysis of consecutive patients with primary ovarian cancer who underwent radical multivisceral surgery between 01/2003 and 12/2010 under either general anesthesia plus opioid analgesia (group A) or general anesthesia plus epidural anesthesia (group B), was performed. Cancer recurrence-free survival and total survival times after surgery were compared between the groups using Mann-Whitney test. The analysis was strengthened by Kaplan-Meier survival estimates for each group with comparison using the log-rank test. Results: Data of 105 (88%) of patients (group A: 33; group B: 72) were available for analysis. The median (interquartile range-IQR) follow-up time 27 (17-58) months. The groups were comparable regarding age, body-mass index, ASA physiological status, FIGO staging, tumor residual and use of adjuvant platinum-based chemotherapy. The median (IQR) time to recurrence of cancer was 31 (15-63) months in group A vs. 18 (10-35) months in group B (p = 0.017). Longer recurrence-free survival was associated with general anesthesia and opioid analgesia (hazard ratio 1.52; 95% confidence interval 1.4-1.56; p = 0.008). Conclusions: In contrast to previous investigations, perioperative epidural anesthesia was associated with decreased survival in patients after ovarian cancer surgery.

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