Optimization of anesthetic management of peri- and postoperative period in patients under surgical treatment of colorectal cancer. Part I.

Authors

  • K. O. Chebanov КУ «Днепропетровска городская многопрофильная клиническая больница №4 Днепропетровского областного совета», Ukraine
  • I. V. Baranov КУ «Днепропетровска городская многопрофильная клиническая больница №4 Днепропетровского областного совета», Ukraine
  • S. P. Novikov КУ «Днепропетровска городская многопрофильная клиническая больница №4 Днепропетровского областного совета», Ukraine
  • Y. I. Olefir КУ «Днепропетровска городская многопрофильная клиническая больница №4 Днепропетровского областного совета», Ukraine
  • S. A. Grishko КУ «Днепропетровска городская многопрофильная клиническая больница №4 Днепропетровского областного совета», Ukraine
  • A. V. Vasilishin КУ «Днепропетровска городская многопрофильная клиническая больница №4 Днепропетровского областного совета», Ukraine
  • R. K. Karas КУ «Днепропетровска городская многопрофильная клиническая больница №4 Днепропетровского областного совета», Ukraine

DOI:

https://doi.org/10.26641/1997-9665.2015.2.85-90

Keywords:

colorectal cancer, low-flow anesthesia, combined anesthesia, epidural analgesia, sevoflurane

Abstract

Background. At the present stage of medicine development colorectal cancer is an actual medical and socio-economical problem. Because surgical is the primary method of treatment the question of how does method of anesthesia and postoperative analgesia influence on the processes of metastasis and survival of cancer patients becomes relevant. Objective. The purpose of research is to select the optimal method of anesthesia protection of patients from operating aggression during surgical treatment of colorectal cancer. Methods. It was performed a comparative analysis of clinical data and results of treatment using total intravenous anesthesia followed analgesia with opiates analgesics, and combined techniques using low-flow sevoflurane anesthesia and epidural analgesia, followed by prolonged epidural anesthesia. Results. It was shown a significant advantage of combined techniques in comparison with total intravenous anesthesia due to: normodynamic type of hemodynamics during operation, possibility to extubate patient in operating room, effective analgesia in early postoperative period. Methods of prolonged epidural analgesia provided a significant need reduction for opioid analgesics, efficient analgesia in postoperative period, saved anti-tumor immunity and resistance to metastasis in patients with cancer, has provided more early resumption of intestine motor function, reduced terms of patient's staying in the intensive care unit. Implemented methodology reduced the frequency of postoperative mortality, complications, average length of hospital stay and frequency of patient returns to intensive care unit. Conclusion. Combined techniques of low-flow sevoflurane anesthesia and epidural analgesia, followed by prolonged epidural anesthesia is an optimal method of anesthesia protection of patients from operating aggression during surgical treatment of colorectal cancer.

References

  1. American Cancer Society. Colorectal Cancer Facts & Figures 2014-2016. Atlanta: American Cancer Society. 2014. 32 p.
  2. [Bulletin of national cancer registry of Ukraine 2015]. Vol. 16. Ukrainian.
  3. Ovechkin AM, Sviridov SV. [Post-operative pain and pain management: state of the art]. Emergency medicine. 2011;6:20-31. Russian.
  4. Lennon FE, Moss J, Singleton PA. The μ-opioid receptor in cancer progression: is there a direct effect? Anesthesiology. 2012;116(4):940-5. doi: 10.1097/ALN.0b013e31824b9512.
  5. Mathew B, Lennon FE, Siegler J, Mirzapoiazova T, Mambetsariev N, Sammani S, Gerhold LM, LaRiviere PJ, Chen CT, Garcia JG, Salgia R, Moss J, Singleton PA. The novel role of the mu opioid receptor in lung cancer progression: a laboratory investigation. Anesth. Analg. 2011;112(3):558-67. doi: 10.1213/ANE.0b013e31820568af.
  6. Shavit Y, Lewis JW, Terman GW, Gale RP, Liebeskind JC. Opioid peptides mediate the suppressive effect of stress on natural killer cell cytotoxicity. Science. 1984;223(4632):188-90. PMID: 6691146.
  7. Cata JP, Gottumukkala V, Thakar D, Keerty D, Gebhardt R, Liu DD. Effects of postoperative epidural analgesia on recurrence-free and overall survival in patients with nonsmall cell lung cancer. J. Clin. Anesth. 2014;26(1):3-17. doi: 10.1016/j.jclinane.2013.06.007. PMID: 24095887.
  8. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, Sage D, Futter M, Saville G, Clark T, MacMahon S. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321(7275):1493. PMID: 11118174.
  9. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012;116(2):248-73. PMID: 22227789.
  10. Werner MU, Soholm L, Rotboll-Nielsen P, Kehlet H. Does an acute pain service improve postoperative outcome? Anesth Analg. 2002;95(5):1361-72. PMID: 12401627.
  11. Magdalena D, Georgescu CC, Tantu M. Methods of postoperative analgesia - administration of epidural bupivacaine in patients with colon cancer undergoing surgery. Current Health Sciences Journal. 2013;39(1):35-8.
  12. Oremus K, Safaric Z. The role of epidural anesthesia and analgesia in surgical practice. Ann. Surg. 2004;240(3):561-2; author reply 562. PMID: 15319733.
  13. Biki B, Mascha E, Moriarty DC, Fitzpatrick JM, Sessler DI, Buggy DJ. Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis. Anesthesiology. 2008;109(2):180-7. doi: 10.1097/ ALN.0b013e31817f5b73. PMID: 18648226.

How to Cite

Chebanov, K. O., Baranov, I. V., Novikov, S. P., Olefir, Y. I., Grishko, S. A., Vasilishin, A. V., & Karas, R. K. (2015). Optimization of anesthetic management of peri- and postoperative period in patients under surgical treatment of colorectal cancer. Part I. Морфологія / Morphologia / Morfologìâ, 9(2), 85–90. https://doi.org/10.26641/1997-9665.2015.2.85-90

Issue

Section

Статті