Effects of combined epidural and general anesthesia on intraoperative hemodynamic responses, postoperative cellular immunity, and prognosis in patients with gallbladder cancer

Abstract

Background:This study is supposed to investigate the effects of combined epidural and general anesthesia on intraoperative hemodynamic responses, postoperative cellular immunity, and prognosis in patients with gallbladder cancer (GBC).Methods:One hundred forty-four GBC patients were selected and randomly divided into the general anesthesia (GA) group and the combined epidural-general anesthesia (CEGA) group. Before anesthesia induction (t0), at intubation (t1), at the beginning of surgery (t2), 5 minutes after pneumoperitoneum (t3), at the end of surgery (t4), after recovery of spontaneous breathing (t5), after regaining consciousness (t6), and after extubation (t7), the heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and the depth of anesthesia (bispectral index [BIS]) were detected. Blood samples were separately collected 30 minutes before anesthesia induction (T1), 2 hours after the beginning of surgery (T2), at the end of surgery (T3), 1 day after surgery (T4), 3 days after surgery (T5). The survival rates of T cell subsets (CD3+, CD4+, CD8+, CD4+/CD8+) and natural killer (NK) cells were determined by flow cytometry. Postoperative nausea and vomiting (PONV), visual analog scale (VAS), and sedation-agitation scale (SAS) were performed to assess postoperative adverse reactions. A 3-year follow-up was conducted.Results:Compared with the GA group, the CEGA group had significant lower SBP values at t5 and t6, lower DBP values at t1, t3, t4, and t5, lower HR values at t1 and t5, and higher BIS values at t4, t5, t6, and t7. No PONV was observed in the CEGA group. In comparison to the GA group, the VAS was markedly increased and survival rates of CD3+, CD4+, and CD4+/CD8+ cells were increased at T2, T3, T4, and T5 in the CEGA group. The 1-year, 2-year, and 3-year survival rates were not evidently different between the CEGA group and the GA group.Conclusion:Our study provides evidence that the combined epidural-general anesthesia might attenuate intraoperative hemodynamic responses and improve postoperative cellular immunity, so that it might be a more available anesthesia method for GBC patients.

A randomized controlled trial on analgesic effect of repeated Quadratus Lumborum block versus continuous epidural analgesia following laparoscopic nephrectomy

“…The epidural group showed lower MAP and required more ephedrine during observation compared to the QLB group. Epidural analgesia especially using high concentration more than 0.1% bupivacaine or equivalent ropivacaine dose has unfavorable side effects such as hypotension, especially in patients at risk of hemodynamic instability [10, 19] Zhu and colleagues found the combination of thoracic epidural and general anesthesia had lower systolic, diastolic and pulse pressure compared with general anesthesia alone in laparoscopic cholecystectomy [22].…”

Perioperatives Flüssigkeitsmanagement bei großen viszeralchirurgischen Eingriffen

“…Sowohl Vollnarkosen als auch rückenmarknahe Verfahren können mit einer u. a. durch Sympathikolyse verursachten Vasodilatation und entsprechender Flüssigkeitsverschiebung einhergehen [ 42 ]. Zusätzlich verstärkt die Kombination von Peridural- und Allgemeinanästhesie diesen Effekt und kann zu einem erhöhten Volumenbedarf führen [ 146 ].…”

A Randomised Controlled Trial on Analgesic Effect of Repeated Quadratus Lumborum Block Versus Continuous Epidural Analgesia Following Laparoscopic Nephrectomy

“…11 Zhu and colleagues found the combination of thoracic epidural and general anaesthesia had lower systolic, diastolic and pulse pressure compared with general anaesthesia alone in laparoscopic cholecystectomy. 30 Our study had several limitations. There was a lack of blinding because of the QLB was bilateral injections without catheter inserted and the epidural block had a catheter inserted.…”