Anesthetic support during total laryngectomy: current status and feasibility of optimization

Abstract

Topicality: Despite progress in global medicine, optimization of surgical treatment of laryngeal cancer remains an urgent task due to adverse postoperative consequences and poor patient survival. Anesthetic support during total laryngectomy needs to be improved due to the possible undesirable effect of the standard scheme of intraoperative management of patients. Aim: to evaluate the effectiveness of anesthetic support during total laryngectomy using standard doses of opioids, the severity of side effects in the early postoperative period, and the feasibility of finding alternative pain relief schemes. Materials and methods: 25 patients with T3-4N0-3M0 laryngeal cancer who underwent radical surgical treatment were examined. During total laryngectomy, patients were anesthetized using standard doses of opioids without the use of adjuvant components of anesthesia. Anesthesia control was carried out on the basis of monitoring the bispectral index (BIS) and changes in the index of analgesia and nociception (ANI). In dynamics, biochemical and immunological studies of the blood of patients were carried out. Assessment of pain syndrome was carried out according to VAS indicators. Statistical analysis was carried out using classical methods of descriptive and analytical statistics using the software product STATISTICA v.6.1 (Statsoft Inc., USA, license number AGAR909E415822FA). Results and discussion: An analysis of anesthetic support during total laryngectomy using standard doses of opioids showed that the condition of patients after surgery is characterized by a certain immunosuppression with lymphopenia, a decrease in the level of interleukin 2 and tumor necrosis factor alpha, which lasts 48 hours and is most pronounced at 2-day after surgery. As a result of the study, the dependence of the pain syndrome in patients with total laryngectomy on the injected dose of opioids was revealed – the more opioids are used intraoperatively, the more patients needed them after the operation. This phenomenon is associated with the sensitization of opioid receptors and the development of tolerance, which further leads to hyperalgesia. An increase in the dose of the painkiller also led to an immunosuppressive effect in the examined patients, which was manifested primarily in a decrease in the level of IL-2, which is a potentially unfavorable factor in the proliferation and subsequent invasion of cancer cells. Conclusions: From the given data, it follows that the introduction of new anesthetic schemes using the principles of multimodal anesthesia and the principles of opioid-limiting anesthesia should be used in patients with laryngeal cancer during total laryngectomy.