scholarly journals Opioid-free anesthesia compared to opioid anesthesia for lung cancer patients undergoing video-assisted thoracoscopic surgery: A randomized controlled study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257279
Author(s):  
Guangquan An ◽  
Yiwen Zhang ◽  
Nuoya Chen ◽  
Jianfeng Fu ◽  
Bingsha Zhao ◽  
...  
Keyword(s):  
Blood Glucose ◽  
General Anesthesia ◽  
Pain Threshold ◽  
Thoracoscopic Surgery ◽  
Glucose Levels ◽  
Video Assisted ◽  
Blood Glucose Levels ◽  
Anesthesia Group ◽  
Intraoperative Pain ◽  
Video Assisted Thoracoscopic Surgery

Background Reducing intra-operative opioid consumption benefits patients by decreasing postoperative opioid-related adverse events. We assessed whether opioid-free anesthesia would provide effective analgesia-antinociception monitored by analgesia index in video-assisted thoracoscopic surgery. Methods Patients (ASA Ⅰ-Ⅱ, 18–65 years old, BMI <30 kg m−2) scheduled to undergo video-assisted thoracoscopic surgery under general anesthesia were randomly allocated into two groups to receive opioid-free anesthesia (group OFA) with dexmedetomidine, sevoflurane plus thoracic paravertebral blockade or opioid-based anesthesia (group OA) with remifentanil, sevoflurane, and thoracic paravertebral blockade. The primary outcome variable was pain intensity during the operation, assessed by the depth of analgesia using the pain threshold index with the multifunction combination monitor HXD‑I. Secondary outcomes included depth of sedation monitoring by wavelet index and blood glucose concentration achieved from blood gas. Results One hundred patients were randomized; 3 patients were excluded due to discontinued intervention and 97 included in the final analysis. Intraoperative pain threshold index readings were not significantly different between group OFA and group OA from arriving operation room to extubation (P = 0.86), while the brain wavelet index readings in group OFA were notably lower than those in group OA from before general anesthesia induction to recovery of double lungs ventilation (P <0.001). After beginning of operation, the blood glucose levels in group OFA increased compared with baseline blood glucose values (P < 0.001). The recovery time and extubation time in group OFA were significantly longer than those in group OA (P <0.007). Conclusions This study suggested that our OFA regimen achieved equally effective intraoperative pain threshold index compared to OA in video-assisted thoracoscopic surgery. Depth of sedation was significantly deeper and blood glucose levels were higher with OFA. Study’s limitations and strict inclusion criteria may limit the external validity of the study, suggesting the need of further randomized trials on the topic. Trial registration: ChiCTR1800019479, Title: "Opioid-free anesthesia in video-assisted thoracoscopic surgery lobectomy".

scholarly journals May awake video-assisted thoracoscopic surgery with thoracic epidural anesthesia use routinely for minimaly invasive thoracic surgery procedures in the future?

2018 ◽  
Vol 5 (5) ◽  
pp. 1602
Author(s):  
Gonul Sagiroglu ◽  
Fazli Yanik ◽  
Yekta A. Karamusfaoglu ◽  
Elif Copuroglu
Keyword(s):  
Thoracic Surgery ◽  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Thoracoscopic Surgery ◽  
Lung Ventilation ◽  
Thoracic Epidural Anesthesia ◽  
One Lung Ventilation ◽  
Thoracic Epidural ◽  
Video Assisted ◽  
Video Assisted Thoracoscopic Surgery

Background: In the last years thoracic surgery developed in greater extent with equipments and techniques in one lung ventilation. Still general anesthesia in one lung ventilation approved as gold standard. In thoracic surgery most performed surgeries are plerural decortication and lung biopsy. Avoidance of intubation in Video Assisted Thoracoscopic Surgery (VATS) procedures gains us some advantages in postoperative period; a better respiratory parameters, survival and morbidity mortality rates, reduced hospitalization time and costs, reduced early stress hormone and immune response.  Methods: In this study, we reported our experience of 24 consecutive patients undergoing VATS with Thoracic Epidural Anesthesia (TEA) between December 2015 through July 2016 to evaluate the feasibility, safety and indication of this innovative technique whether it will be a gold standart in thoracic surgeries or not in the future.Results: Operation procedures included wedge resection in 11 (46%) patients (eight of them for pneumothorax, three of them for diagnosis), in 10 (42%) patients pleural biopsy (eight of them used talc pleurodesis), in two (8%) patients air leak control with fibrin glue and in one (4%) patient bilateral thoracal sympathectomy for hyperhidrosis.  We used T4-5 TEA space for 17 (72%) of patients, while we used T4-6 TEA space for 7 (28%) of patients. TEA block reached the desired level after the mean 26.4±4.3 minutes (range 21-34 min). There was no occurrence of hypotension and bradycardia during and after TEA. One (4%) patient required conversion to general anesthesia and tracheal intubation because of significant diaphragmatic contractions and hyperpne. Conversion to thoracotomy was not needed in any patient.Conclusions: We conclude that nVATS procedure with aid of TEA is feasibile and safety with minimal adverse events. The procedure can have such advantages as early mobilization, opening of early oral intake, early discharge, patient satisfaction, low pain level. Nevertheless, there is a need for randomized controlled trials involving wider case series on the subject.

scholarly journals Anesthetic Substitute of Intraoperative Regional Anesthesia of Nonintubated or Endotracheal-intubated Video-assisted Thoracoscopic Surgery With Thoracoscopic Multilevel Intercostal Nerve Blocks: a Randomized Study

2021 ◽  
Author(s):  
Kuang-Cheng Chan ◽  
Li-Lin Wu ◽  
Su-Chuan Han ◽  
Jin-Shing Chen ◽  
Ya-Jung Cheng
Keyword(s):  
General Anesthesia ◽  
Regional Anesthesia ◽  
Surgical Stress ◽  
Thoracoscopic Surgery ◽  
Intercostal Nerve ◽  
General Anesthetics ◽  
Nerve Blocks ◽  
Video Assisted ◽  
First Case ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background:A reduced need for general anesthetics and enhanced effectiveness of postoperative analgesia have been reported for multimodal anesthesia, which involves combining regional and general anesthesia. Ideal regional anesthesia to combine with general anesthesia should match but not overdo with the surgical stress from corresponding operations. However, as thoracic operation becomes less invasive, the substitute effects on intraoperative analgesia or consciousness by regional anesthesia such as with thoracoscopic intercostal nerve blocks (TINBs) for managing corresponding surgical stress in intubated or non-intubated video-assisted thoracoscopic surgery (VATS) have been inadequately studied. The goals of this study is to investigate the substituve of TINBs on analgesia and consciousness for intubated and non-intubated uniport VATS operations.Methods:Sixty patients who received VATS with target-controlled infusions of propofol and remifentanil were recruited. Patients were randomized into intubated and nonintubated groups. Intraoperative multilevel (T3–T8) TINBs were performed after artificial pneumothorax and before VATS operations. The effects of substitute on analgesia by TINBs for VATS operations were indicated by changes on blood pressure and the Ce of remifentanil to maintain normotension. EEG data with a density spectral array (DSA) and data on the effect-site concentration (Ce) of propofol goaled with bispectral index (BIS) levels between 40-60were compared to determine whether TINBs affect consciousness. Results:TINBs with 0.5% bupivacaine provide substitute more than required on analgesia for intubated and non-intubated uniport VATS operations. The Ce of remifentanil was significantly decreased beginning 10 min after TINBs in both groups (p < 0.001). In the nonintubated VATS (NIVATS) group, a significantly lower mean arterial pressure after introducing TINBs persisted for 20 min. TINBs demonstrated a DSA smoothing effect despite the subsequent VATS. The Ce of the propofol infusion decreased 5 min after TINBs in both NIVATS (p < 0.001) and intubated VATS (IVATS; p = 0.252) groups. The Ce of remifentanil was significantly higher in parallel for the IVATS group than for the NIVATS group (p < 0.001).Conclusions:Intraoperative TINBs with 0.5 % bupivacaine provides substitutes on analgesia and hyponosis more than required for uniportal intubated or non-intubated VATS operations. Situations involving endotracheal tubes required more analgesia but does not affect the substitute effects of TINBs.Trial registration: ClinicalTrials. gov, NCT03874403. This study was approved by the Research Ethics Committee of National Taiwan University Hospital, Taipei, Taiwan (201712125RINB) on February 2, 2018. We then enrolled our first case on November 1, 2018 - Retrospective registered on February 28, 2019, https://clinicaltrials.gov/ct2/show/record/NCT03874403

scholarly journals Perbandingan kadar gula darah pasca pembedahan dengan anestesia umum dan anestesia spinal

e-CliniC ◽  
2016 ◽  
Vol 4 (2) ◽  
Author(s):  
Fabiola I. Lumanauw ◽  
Harold F. Tambajong ◽  
Barry I. Kambey
Keyword(s):  
Blood Glucose ◽  
Stress Response ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Random Sampling ◽  
Observational Research ◽  
P Value ◽  
Cross Sectional ◽  
Glucose Levels ◽  
Blood Glucose Levels

Abstract: Anesthesia and surgery could evoke stress response that can affect blood glucose levels. The purpose of this study is to compare the blood glucose levels after surgery with general anesthesia and spinal anesthesia. This was an analytic prospective observational research with cross-sectional design. Researched on 32 patients by consecutive random sampling who meet inclusion and exclusion criteria, then divided into two groups, namely the group undergoing surgery with general anesthesia and the group undergoing surgery with spinal anesthesia. Measurements of blood glucose levels was done in 1 hour before induction of premedication and 4 hours after surgery. The statistical analysis were done using Shapiro-Wilk Test to determine the normal distribution of samples, and independent t-test to compare blood glucose levels after surgery with general anesthesia and spinal anesthesia. The result showed there was significantly different between blood glucose levels after surgery with general anesthesia and spinal anesthesia (p-value = 0.006 or p <0.05). Mean of blood glucose level after surgery in general and spinal anesthesia were 96 mg/dl and 79,4 mg/dl. Conclusion: General anesthesia had more influence on the increase in blood glucose levels after surgery compared to spinal anesthesia.Keywords: stress response, blood glucose levels, general anesthesia, spinal anesthesia Abstrak: Anestesia dan pembedahan akan menyebabkan timbulnya respon stres yang dapat mempengaruhi kadar gula darah. Penelitian ini bertujuan untuk mengetahui perbandingan kadar gula darah pasca pembedahan dengan anestesia umum dan anestesia spinal. Metode penelitian ini menggunakan desain observasional analitik prospektif dengan rancangan cross-sectional. Penelitian dilakukan terhadap 32 pasien yang didapatkan secara consecutive random sampling yang memenuhi kriteria inklusi dan eksklusi, lalu dibagi menjadi 2 kelompok, yaitu kelompok yang menjalani pembedahan dengan anestesia umum dan kelompok yang menjalani pembedahan dengan anestesia spinal. Pengukuran kadar gula darah dilakukan 2 kali, yaitu 1 jam sebelum induksi premedikasi dan 4 jam setelah pembedahan. Analisis statistik dilakukan dengan uji Shapiro-Wilk untuk mengetahui normalitas distribusi sampel, dan uji-t independen untuk membandingkan kadar gula darah pasca pembedahan dengan anestesia umum dan anestesia spinal. Hasil penelitian menunjukkan perbedaan yang bermakna antara kadar gula darah pasca pembedahan dengan anestesia umum dan anestesia spinal (nilai p = 0,006 atau p < 0,05). Rerata kadar gula darah pasca pembedahan dengan anestesia umum sebesar 96 mg/dl, sedangkan pada anestesia spinal sebesar 79,4 mg/dl. Simpulan: Anestesia umum lebih berpengaruh terhadap peningkatan kadar gula darah pasca pembedahan dibandingkan dengan anestesia spinal. Kata kunci : respon stres, kadar gula darah, anestesia umum, anestesia spinal

Sign in / Sign up

Export Citation Format

Share Document