Comparison of Pulmonary Morbidity Using Sevoflurane or Propofol-Remifentanil Anesthesia in an Ivor Lewis Operation

Lee, Jeong Jin; Kim, Chan Yun; Kim, Jie Ae; Yang, Mikyoung; Ahn, Hyun Joo; Sim, Woo Seog; Park, Ki Jeong; Jun, Byung Hui

doi:10.1053/j.jvca.2012.01.015

Cited by 26 publications

(45 citation statements)

References 24 publications

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“…47 In contrast, several other studies show that halogenated anesthesia attenuates the inflammatory response. 48,49 Another recent study, concerning the inflammatory response in major abdominal surgery, reveals that there are no statistically significant differences between total intravenous anesthesia and inhalational anesthesia. 50 Finally, the baseline pulmonary functional test results were a bit lower than predicted, likely due to the method of measurement.…”

Section: Perioperative Medicinementioning

confidence: 99%

Protective Mechanical Ventilation during General Anesthesia for Open Abdominal Surgery Improves Postoperative Pulmonary Function

et al. 2013

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Background: The impact of intraoperative ventilation on postoperative pulmonary complications is not defined. The authors aimed at determining the effectiveness of protective mechanical ventilation during open abdominal surgery on a modified Clinical Pulmonary Infection Score as primary outcome and postoperative pulmonary function. Methods: Prospective randomized, open-label, clinical trial performed in 56 patients scheduled to undergo elective open abdominal surgery lasting more than 2 h. Patients were assigned by envelopes to mechanical ventilation with tidal volume of 9 ml/kg ideal body weight and zero-positive end-expiratory pressure (standard ventilation strategy) or tidal volumes of 7 ml/kg ideal body weight, 10 cm H2O positive end-expiratory pressure, and recruitment maneuvers (protective ventilation strategy). Modified Clinical Pulmonary Infection Score, gas exchange, and pulmonary functional tests were measured preoperatively, as well as at days 1, 3, and 5 after surgery. Results: Patients ventilated protectively showed better pulmonary functional tests up to day 5, fewer alterations on chest x-ray up to day 3 and higher arterial oxygenation in air at days 1, 3, and 5 (mmHg; mean ± SD): 77.1 ± 13.0 versus 64.9 ± 11.3 (P = 0.0006), 80.5 ± 10.1 versus 69.7 ± 9.3 (P = 0.0002), and 82.1 ± 10.7 versus 78.5 ± 21.7 (P = 0.44) respectively. The modified Clinical Pulmonary Infection Score was lower in the protective ventilation strategy at days 1 and 3. The percentage of patients in hospital at day 28 after surgery was not different between groups (7 vs. 15% respectively, P = 0.42). Conclusion: A protective ventilation strategy during abdominal surgery lasting more than 2 h improved respiratory function and reduced the modified Clinical Pulmonary Infection Score without affecting length of hospital stay.

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Section: Perioperative Medicinementioning

confidence: 99%

Protective Mechanical Ventilation during General Anesthesia for Open Abdominal Surgery Improves Postoperative Pulmonary Function

et al. 2013

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“…55 Another prospective trial randomized 48 patients, undergoing Ivor Lewis operation, to receive sevoflurane or total intravenous anesthesia. 56 In this population, volatile anesthesia attenuated the increase of IL-6 blood concentration at the end of surgery; however, postoperative pulmonary morbidity was similar between cohorts. 56 Another further prospective study compared the effects of propofol and sevoflurane anesthesia with respect to perioperative immune response in 58 patients undergoing laparoscopic radical hysterectomy for cervical cancer.…”

Section: Current Evidence On the Effects Of Anesthesia On Short And Lmentioning

confidence: 72%

“…56 In this population, volatile anesthesia attenuated the increase of IL-6 blood concentration at the end of surgery; however, postoperative pulmonary morbidity was similar between cohorts. 56 Another further prospective study compared the effects of propofol and sevoflurane anesthesia with respect to perioperative immune response in 58 patients undergoing laparoscopic radical hysterectomy for cervical cancer. 57 Compared to volatile-based anesthesia, a propofol-based anesthesiologic strategy was characterized by a lower immunosuppression during the perioperative period; however, no differences in short-term adverse consequence, such as hospital stay and infection rate, were reported between groups.…”

Section: Current Evidence On the Effects Of Anesthesia On Short And Lmentioning

confidence: 72%

<p>Anesthetic Strategies in Oncological Surgery: Not Only a Simple Sleep, but Also Impact on Immunosuppression and Cancer Recurrence</p>

Longhini¹,

Bruni²,

Garofalo³

et al. 2020

CMAR

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Tumor recurrences or metastases remain a major hurdle in improving overall cancer survival. In the perioperative period, the balance between the ability of the cancer to seed and grow at the metastatic site and the ability of the patient to fight against the tumor (i.e. the host antitumor immunity) may determine the development of clinically evident metastases and influence the patient outcome. Up to 80% of oncological patients receive anesthesia and/or analgesia for diagnostic, therapeutic or palliative interventions. Therefore, anesthesiologists are asked to administer drugs such as opiates and volatile or intravenous anesthetics, which may determine different effects on immunomodulation and cancer recurrence. For instance, some studies suggest that intravenous drugs, such as propofol, may inhibit the host immunity to a lower extent as compared to volatile anesthetics. Similarly, some studies suggest that analgesia assured by local anesthetics may provide a reduction of cancer recurrence rate; whilst on the opposite side, opioids may exert negative consequences in patients undergoing cancer surgery, by interacting with the immune system response via the modulation of the hypothalamic-pituitary-adrenal axis and autonomic nervous system, or directly through the opioid receptors on the surface of immune cells. In this review, we summarize the main findings on the effects induced by different drugs on immunomodulation and cancer recurrence.

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“…Studies dealing with the role of anesthetic agents on lung inflammation produced conflicting results. Indeed, propofol yields a pro-inflammatory effect, contrasting with the halogenated anesthetics (92,93). A recent work on pigs reports just the opposite (94), whereas no difference has also been described (95).…”

Section: Anesthesiamentioning

confidence: 99%

Artificial ventilation during pneumoperitoneum

Comuzzi¹

2014

SOB

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the complications pertaining to pneumoperitoneum to solve them quickly, paying particular attention to the patients at higher risk, such as elderly, obese, and those with cardiopulmonary disease. KEY WORDS: pneumoperitoneum, artificial ventilation, obesity, laparoscopy, anesthesia. IntroductionLaparoscopic surgery has been increasingly employed in various surgical subspecialties because of its innumerous benefits. These are evident during the post-operative period and result from the less important organ/tissue trauma caused by laparoscopic approaches than those triggered by open surgery. The main advantages of laparoscopic surgery are: reduction of the inflammatory and metabolic responses (1-3), reduced post-operative pain and analgesic consumption (2, 3), smaller incidence of respiratory complications (2), faster resolution of post-operative ileum and recovery (1). Taken together, these outcomes reduce hospital stay, promote a quicker return to normal daily activities (2-4), and reduce the cost of the treatment (4). On the other hand, laparoscopic surgery presents some challenges regarding the intra-operative anesthesia management, since there are respiratory and hemodynamic changes pertaining to the general anesthesia itself, to the abdominal insufflation, and to the intra-operative positioning of the patient (5). These issues become even more evident in patients with cardiopulmonary disease or obesity (6). This review focuses on the intra-operative respiratory alterations caused by laparoscopy and on the ventilatory strategies that are prone to minimize the modifications evoked by the technique. Alterations of the respiratory systemIn order to allow an adequate observation of the surgical field, laparoscopic surgery requires controlled gas insufflation into the peritoneal cavity (pneumoperitoneum). For this purpose, carbon dioxide is regularly used under a pressure of 10-15 mmHg. Naturally, respiratory issues related to mechanics and CO2 overload SummaryLaparoscopic surgery has been increasingly used in many surgical subspecialties, due to its various post-operative benefits. On the other hand, it presents intra-operative challenges to the anesthesia management. The inflation of the abdominal cavity with carbon dioxide leads to hemodynamic changes, mechanical respiratory system derangements (increased elastance, resistance and airway pressure), augmented V'CO2, and alterations of the V'/Q' ratio and of the PaCO2-PetCO2 gradient. All these changes may be influenced by other factors, such as body position and baseline characteristics of the patient. To minimize the negative consequences of these modifications a protective ventilation strategy with the use of low tidal volumes and PEEP, eventually associated with recruitment maneuvers, is suggested. No ventilatory mode or anesthetic drug has been proven better than the others. It has been suggested that the use of supraglotic devices may be a safe alternative to endotracheal intubation during laparoscopic surgery. It is important that the anesthetist be aware ...

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Comparison of Pulmonary Morbidity Using Sevoflurane or Propofol-Remifentanil Anesthesia in an Ivor Lewis Operation

Cited by 26 publications

References 24 publications

Protective Mechanical Ventilation during General Anesthesia for Open Abdominal Surgery Improves Postoperative Pulmonary Function

Protective Mechanical Ventilation during General Anesthesia for Open Abdominal Surgery Improves Postoperative Pulmonary Function

<p>Anesthetic Strategies in Oncological Surgery: Not Only a Simple Sleep, but Also Impact on Immunosuppression and Cancer Recurrence</p>

Artificial ventilation during pneumoperitoneum

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