The effects of combined epidural and general anesthesia on the autonomic nervous system and bioavailability of nitric oxide in patients undergoing laparoscopic pelvic surgery

Shin, Seokyung; Bai, Sun Joon; Rha, Koon Ho; So, Yun Mi; Oh, Young Jun

doi:10.1007/s00464-012-2536-5

Cited by 16 publications

(9 citation statements)

References 38 publications

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“…20 The blood pressure increases because of the increased intra- abdominal pressure or increased PaCO 2 , which causes systemic vascular resistance to increase. 21 In this current study, the inflation pressure was limited within 8-14 mmHg during laparoscopic surgery. PaCO 2 increased significantly after pneumoperitoneum creation.…”

Section: Discussionmentioning

confidence: 99%

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Influence of laparoscopic carbon dioxide pneumoperitoneum on neonate circulation and respiration

Zhang

et al. 2013

J Int Med Res

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Section: Discussionmentioning

confidence: 99%

“…20 The blood pressure increases because of the increased intra-abdominal pressure or increased PaCO 2 , which causes systemic vascular resistance to increase. 21…”

Section: Discussionmentioning

confidence: 99%

Influence of laparoscopic carbon dioxide pneumoperitoneum on neonate circulation and respiration

Zhang

et al. 2013

J Int Med Res

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“…A combination of general and epidural anaesthesia may reduce the severity of diaphragmatic dysfunction in the postoperative period following robot-assisted laparoscopic RP compared to conventional general anaesthesia (18). Studies have also shown that combined general and thoracic epidural anaesthesia positively affect NO inactivation and oxidative stress (19).…”

Section: Discussionmentioning

confidence: 99%

The efficacy of regional analgesia techniques in urological robotic surgeries: a retrospective clinical study

et al. 2022

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Objective: The advantages of robot-assisted surgery include shorter incisions, less postoperative pain, perioperative blood loss, and a faster return to daily functions. Thoracic epidural analgesia (TEA) provides highly satisfactory analgesia in abdominal surgery. However, its hypotensive effect, particularly in minimally invasive procedures, exceeds its contribution to rapid recovery. Fascial plane blocks may be more beneficial in that context. This study evaluated the effects of regional analgesia techniques in robotic prostatectomy, nephrectomy, and cystectomy operations. Material and Methods: Following IRB Ethics Committee approval (2021.467.IRB1.134), the records of patients who had undergone robotic prostatectomy, nephrectomy, and cystectomy surgeries were retrospectively reviewed between January 2018 and January 2022. Results: One hundred and forty patients with full documentation were included in this study. Various regional analgesia methods were used. Fascial plane blocks were seen to be used in addition to epidural analgesia. Transversus abdominis plane (TAP) and rectus sheath blocks exhibited satisfactory results in robotic prostate surgeries and TAP blocks in robotic nephrectomy operations. Conclusion: In robotic prostatectomy and nephrectomy operations, we recommend fascial plane blocks as the first-choice method for postoperative analgesia. Keywords: regional anesthesia, robotic surgery, radical prostatectomy, minimally invasive surgery, fascial plane blocks, recovery after surgery

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“…Other circulating factors recognised to be differentially influenced by minimally invasive surgery include immunoglobulins and the related T and B cells, although these factors are also affected by blood loss. Neurendocrine factors also affect the stress response in surgical patients [35] but have not been analysed in prospective randomised trials of minimally invasive surgery. These factors may also reflect anaesthesia levels, which are often lower in minimally invasive surgery.…”

Section: Circulating Cellular and Humoral Mediators Of Surgical Stress Affected Differentially By Minimally Invasive Surgerymentioning

confidence: 99%

Cellular and Humoral Responses following Minimally Invasive Surgery: Role of Reactive Oxygen Species

Leaver

Rotondo

Walker

2015

CMB

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Surgery is associated with release of local and systemic mediators which influence vascular and tissue homeostasis. The post-surgical release of acute phase reactants, particularly IL-6 and CRP, is reduced in minimally invasive surgery, compared with conventional surgery. Additionally, there is emerging evidence that leukocytes and Reactive Oxygen Species (ROS) are affected differentially by minimally invasive surgery. ROS and mediators of oxidative stress influence vascular endothelium, organ perfusion and angiogenesis, and may be critical determinants of survival and outcome. ROS also influence cell proliferation and cell death and have been implicated in neoplastic signalling. Advances in ROS detection and oxidative stress signalling have shown cellular changes affected by minimally invasive surgery. It has been observed that the invasiveness of surgery is proportional to changes in phagocyte and lymphocyte ROS. A potential role for ROS signalling in the immune system is suggested by evidence of closer ROS/leukocyte correlation in patients undergoing minimally invasive surgery. At lower ROS levels, phagocyte and lymphocyte ROS following minimally invasive surgery implicate a homeostatic response with closer leukocyte/ROS correlations, whereas higher ROS in open surgery and greater leukocyte depletion indicates more cytotoxic signalling.Interactions between humoral and cellular elements suggest that an integrated systems approach, using individual patient responses, should be used to analyse the response to surgical trauma and oxidative stress. These studies are being used to investigate ROS as biomarkers of the effects of surgery on vascular and pulmonary reactivity. ROS signalling may provide insights into post surgical trauma and its underlying pathology.

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The effects of combined epidural and general anesthesia on the autonomic nervous system and bioavailability of nitric oxide in patients undergoing laparoscopic pelvic surgery

Abstract: Combined epidural and general anesthesia effectively blocks SNS stimulation during laparoscopic surgery and reduces NO inactivation and oxidative stress.

Cited by 16 publications

References 38 publications

Influence of laparoscopic carbon dioxide pneumoperitoneum on neonate circulation and respiration

Influence of laparoscopic carbon dioxide pneumoperitoneum on neonate circulation and respiration

The efficacy of regional analgesia techniques in urological robotic surgeries: a retrospective clinical study

Cellular and Humoral Responses following Minimally Invasive Surgery: Role of Reactive Oxygen Species

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