DOI: https://doi.org/10.22141/2224-0586.5.92.2011.143248

Using epidural anesthesia with preserved spontaneous breathing in oncological patients during long-term gynecological laparoscopic interventions

M.V. Krasnoselskiy, Ye.M. Krutko, M.V. Shulga, V.G. Seredenko, Ye.V. Shulga

Abstract


Background. To maintain spontaneous breathing with comfortable anesthesia using epidural ane­sthesia for many hours of surgery, it is necessary to study more thoroughly the possibility of conducting it with advanced therapy of possible complications and a comfortable state for patients. Objective: studying and justification of the expediency of using epidural anesthesia with sedation on spontaneous breathing in cancer patients during prolonged gynecological laparoscopic interventions to provide anesthesia with advanced the­rapy of possible complications and obtain a more comfortable condition of patients. Materials and methods. A study was carried out among 64 patients aged 62.6 ± 2.1 years with ovarian, uterine and cervical cancer with gynecological laparoscopic interventions, ASA I and II, whо were stratified depending on anesthesia: group А (control; n = 25) — combined general anesthesia with epidural analgesia according to standard protocols, and group B (n = 39) — epidural anesthesia on spontaneous breathing with sedation. Plasma concentrations of interleukin-6 and -8 cytokines were measured before and 4 and 24 hours after the operation. Health-related quality of life was evaluated with the help of the standard Short Health Status Assessment Questionnaire (SF-36), using the Evidence methodology. Results. The results show that in the group with anesthesia according to our method, there is an improvement both in the quality of life and the indices of cellular immunity. The absence of significant complications during this type of anesthesia is important. Conclusions. Thus, epidural anesthesia with the addition of propofol or thiopental infusion on spontaneous breathing provides minimal invasiveness in long-term interventions. It is more comfortable for patients and both psychoemotional and economically justified, which indicates its priority use.


Keywords


gynecological laparoscopy; bupivacaine; combined general epidural anesthesia

Full Text:

PDF

References


Gutt C.N., Oniu T., Mehrabi A., Schemmer P., Kashfi A., Kraus T. et al. Circulatory and respiratory complications of carbon dioxide insufflation // Dig. Surg. 2004; 21(2): 95-105. doi: 10.1159/000077038.

Zuckerman R.S., Heneghan S. The duration of hemodynamic depression during laparoscopic cholecystectomy // Surg. Endosc. 2002 Aug; 16(8): 1233-6. doi: 10.1007/s00464-001-9152-0.

Rauh R., Hemmerling T.M., Rist M., Jacobi K.E. Influence of pneumoperitoneum and patient positioning on respiratory system compliance // J. Clin. Anesth. 2001 Aug; 13(5): 361-5. PMID: 11498317.

Bajwa S.J., Kulshrestha A. Anaesthesia for laparoscopic surgery: general vs regional anaesthesia // J. Minim. Access Surg. 2016 Jan-Mar; 12(1): 4-9. doi: 10.4103/0972-9941.169952.

Mazdisnian F., Palmieri A., Hakakha B., Hakakha M., Cambridge C., Lauria B. et al. Office microlaparoscopy for female sterilization under local anesthesia. A cost and clinical analysis // J. Reprod. Med. 2002 Feb; 47(2): 97-100. PMID: 11883359.

Thwaites A., Edmends S., Smith I. Inhalation induction with sevoflurane: a double-blind comparison with propofol // Br. J. Anaesth. 1997 Apr; 78(4): 356-61. PMID: 9135350.

Iwama H., Obara S., Ozawa S., Furuta S., Ohmizo H., Watanabe K. et al. A survey of combined epidural-propofol ane­sthesia with noninvasive positive pressure ventilation as a minimally invasive anesthetic protocol // Med. Sci. Monit. 2003 Jul; 9(7): CR316-23. PMID: 12883451.

Lin E., Calvano S.E., Lowry S.F. Inflammatory cytokines and cell response in surgery // Surgery. 2000 Feb; 127(2): 117-26. doi: 10.1067/msy.2000.101584.

Ozcan S., Ozer A.B., Yasar M.A., Erhan O.L. Effects of combined general anesthesia and thoracic epidural analgesia on cytokine response in patients undergoing laparoscopic cholecystectomy // Niger. J. Clin. Pract. 2016 Jul-Aug; 19(4): 436-42. doi: 10.4103/1119-3077.183308.

Zabolotskikh I., Trembach N. Safety and efficacy of combined epidural/general anesthesia during major abdominal surgery in patients with increased intracranial pressure: a cohort study // BMC Anesthesiol. 2015, May 15; 15: 76. doi: 10.1186/s12871-015-0056-2.

Pei L., Tan G., Wang L., Guo W., Xiao B., Gao X. et al. Comparison of combined general-epidural anesthesia with general anesthesia effects on survival and cancer recurrence: a meta-ana­lysis of retrospective and prospective studies // PLoS One. 2014, Dec 30; 9(12): e1146-67. doi: 10.1371/journal.pone.0114667.

Xu Q., Zhang H., Zhu Y.M., Shi N.J. Effects of combined general/epidural anesthesia on hemodynamics, respiratory function, and stress hormone levels in patients with ovarian neoplasm undergoing laparoscopy // Med. Sci. Monit. 2016, Nov 8; 22: 4238-46. doi: 10.12659/MSM.897430.

Karlsen R.V., Frederiksen K., Larsen M.B., von Heymann-Horan A.B., Appel C.W., Christensen J. et al. The impact of a breast cancer diagnosis on health-related quality of life. A prospective comparison among middle-aged to elderly women with and without breast cancer // Acta Oncol. 2016 Jun; 55(6): 720-27. doi: 10.3109/0284186X.2015.1127415.

Ishikawa S., Makita K., Sawa T., Toyooka H., Amaha K. Ventilatory effects of laparoscopic cholecystectomy under general anesthesia // J. Anesth. 1997 Sep; 11(3): 179-183. doi: 10.1007/BF02480034.




Copyright (c) 2018 EMERGENCY MEDICINE

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2018

 

   Seo анализ сайта