Regional Versus General Anesthesia in Surgical Patients with Chronic Obstructive Pulmonary Disease

Hausman, Mark S.; Jewell, Elizabeth S.; Engoren, Milo

doi:10.1213/ane.0000000000000574

Cited by 152 publications

(65 citation statements)

References 14 publications

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“… 32 Meta-analysis has demonstrated that regional anaesthesia may protect against development of postoperative pulmonary complications in patients with chronic respiratory diseases. 33 Similarly, a multicentre randomised controlled trial recently reported that regional anaesthesia and analgesia using paravertebral block reduced the risk of postoperative pulmonary complications but not recurrence or mortality in breast cancer after curative surgery compared with systemic opioid therapy. 34 …”

Section: Discussionmentioning

confidence: 98%

Effect of epidural analgesia on cancer prognosis after colon cancer resection: a single-centre cohort study in Taiwan

Tai

Mandell

et al. 2020

BMJ Open

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ObjectivesWhether epidural analgesia affects cancer outcomes remains controversial. Most previous investigations ignored the confounding potential of important pathological factors on cancer outcomes. This study aimed to assess the association between epidural analgesia and cancer recurrence or death after resections for colon cancer.DesignRetrospective cohort study.SettingA single-medical centre in Taiwan.ParticipantsPatients with stage I through III colon cancer undergoing bowel resection and receiving either epidural analgesia or intravenous opioid analgesia from 2005 to 2014.Primary and secondary outcome measuresPrimary outcome was postoperative recurrence-free survival and secondary outcome was overall survival.ResultsA total of 2748 and 1218 patients were analysed before and after propensity score matching. Cox regression analyses did not demonstrate any association between epidural analgesia and recurrence or death after matching (HR 0.89, 95% CI 0.65 to 1.21 for recurrence; 0.72, 95% CI 0.48 to 1.09 for death). Independent prognostic factors for cancer recurrence and death were higher level of preoperative carcinoembryonic antigen, perioperative blood transfusion, advanced cancer stage and pathological lymphovascular invasion.ConclusionsNo definite association was found between epidural analgesia and risk of recurrence or death in patients undergoing colon cancer resection.

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Section: Discussionmentioning

confidence: 98%

Effect of epidural analgesia on cancer prognosis after colon cancer resection: a single-centre cohort study in Taiwan

Tai

Mandell

et al. 2020

BMJ Open

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“…Other studies in the literature also appear to support Paskins's results. Hausman et al [16] performed a study to quantify the benefit of avoiding GA in COPD patients. For this purpose, 2644 "regional" COPD patients (i.e., surgery performed under spinal, epidural or peripheral nerve block anaesthetic techniques) were propensity-score matched to COPD patients who underwent GA and invasive mechanical ventilation.…”

Section: General Anaesthesia and Neuraxial Anaesthesia: Effects On Lumentioning

confidence: 99%

“…These effects could negate the potential benefits of avoiding intraoperative endotracheal intubation and mechanical ventilation [16]. Since NIV can (1) partially compensate for the affected respiratory function by unloading the respiratory muscles and reducing the work of breathing, (2) improve alveolar recruitment with preservation of lung volumes, resulting in better gas exchange, (3) reduce right ventricular preload and left ventricular afterload, and (4) avoid complications of invasive mechanical ventilation [35][36][37][38][39][40], the intraoperative use of NIV along with NA may be, at least in theory, justifiable in some patients with COPD or chest wall and NMDs (Figure 1).…”

Section: Non-invasive Ventilation To Support Lung Function During Neumentioning

confidence: 99%

Non-invasive ventilation during surgery under neuraxial anaesthesia: a pathophysiological perspective on application and benefits and a systematic literature review

Corcione

Karim

Mina

et al. 2019

ait

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Unlike general anaesthesia, neuraxial anaesthesia (NA) reduces the burden and risk of respiratory adverse events in the post-operative period. However, both patients affected by chronic obstructive pulmonary disease (COPD) and chest wall disorders and/or neuromuscular diseases may experience the development or the worsening of respiratory failure, even during surgery performed under NA; this latter negatively affects the function of accessory respiratory muscles, resulting in a blunted central response to hypercapnia and possibly in an exacerbation of cardiac dysfunction (NA-induced relative hypovolemia). According to European Respiratory Society (ERS) and American Thoracic Society (ATS) guidelines, non-invasive ventilation (NIV) is effective in the post-operative period for the treatment of both impaired pulmonary gas exchange and ventilation, while the intra-operative use of NIV in association with NA is just anecdotally reported in the literature. Whilst NIV does not assure a protected patent airway and requires the patient's cooperation, it is a handy tool during surgery under NA: NIV is reported to be successful for treatment of acute respiratory failure; it may be delivered through the patient's home ventilator, may reverse hypoventilation induced by sedatives or inadvertent spread of anaesthetic up to cervical dermatomes, and allow the avoidance of intubation in patients affected by chronic respiratory failure, prolonging the time of non-invasiveness of respiratory support (i.e., neuromuscular patients needing surgery). All these advantages could make NIV preferable to oxygen in carefully selected patients.

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“…Compared with general anesthesia (GA), regional anesthesia can provide more stable hemodynamics and effective opioid-free analgesia [4]. It is also associated with relatively lower incidence of perioperative complications, shorter postoperative stays and greater patient satisfaction [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of additional thoracic paravertebral block in improving anesthetic effects of regional anesthesia for proximal humeral fracture surgery in elderly patients: study protocol for a randomized controlled trial

Wang

Zhang

Xie

et al. 2020

Preprint

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Background: The innervation of shoulder-upper extremity area is complicated and unclear. Regional anesthesia with brachial plexus and cervical plexus block is probably inadequate for the proximal humeral surgery. Missing blockade of T1-T2 nerves may be the reason. We conduct this prospective randomized controlled trial (RCT) to explore whether additional T2 thoracic paravertebral block (TPVB) can improve the success rate of regional anesthesia for elderly patients in proximal humeral fracture surgery. Methods: The patients aged 65 or older, referred for anterior approach proximal humeral fracture surgery, will be enrolled. Each patient will be randomly assigned 1:1 to receive IC block (combined interscalene brachial plexus with superficial cervical plexus block) or ICTP block (combined thoracic paravertebral block with brachial plexus and superficial cervical plexus block). The primary outcome is the success rate of regional anesthesia without rescue analgesic methods. The secondary outcomes are as follows: sensory block at surgical area, proportion of patients who need rescue anesthesia (intravenous remifentanil or conversion to general anesthesia), cumulative doses of intraoperative vasoactive medications and adverse events. The total sample size is estimated to be 80 patients. Discussion: This RCT aims to confirm whether additional T2 TPVB can provide better anesthetic effects of regional anesthesia with brachial and cervical plexus block in elderly patients undergoing proximal humeral surgery.

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Regional Versus General Anesthesia in Surgical Patients with Chronic Obstructive Pulmonary Disease

Abstract: The use of regional anesthesia in patients with COPD is associated with lower incidences of composite morbidity, pneumonia, prolonged ventilator dependence, and unplanned postoperative intubation.

Cited by 152 publications

References 14 publications

Effect of epidural analgesia on cancer prognosis after colon cancer resection: a single-centre cohort study in Taiwan

Effect of epidural analgesia on cancer prognosis after colon cancer resection: a single-centre cohort study in Taiwan

Non-invasive ventilation during surgery under neuraxial anaesthesia: a pathophysiological perspective on application and benefits and a systematic literature review

Effectiveness of additional thoracic paravertebral block in improving anesthetic effects of regional anesthesia for proximal humeral fracture surgery in elderly patients: study protocol for a randomized controlled trial

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