Perioperative Stress Response Research Articles

Stress Response and Analgesia During and after Robotic-Assisted Pelvic Exenteration

Introduction. Thoracic epidural analgesia or thoracic epidural anaesthesia (TEA) and opioid-based intravenous multimodal analgesia (MMA) provide adequate control of perioperative pain, however, comparative data are still to be gathered. Aim. To compare both anesthesia techniques in terms of stress response during and after robotic-assisted pelvic exenteration (PE). Materials and methods. 112 patients were divided into 2 equal groups A level of serum cortisol was measured at induction of anesthesia and in 2, 24, and 48 hours. The efficacy of analgesia was compared using a 10-point numeric pain scale. Analgesic administration and side effects were reported for 1–3 postoperative days. Results. Cortisol levels increased 2 hours after skin incision in the MMA group and only in 24 hours in the TEA group (p < 0.050). Postoperative cortisol levels were significantly lower in the TEA group (p = 0.001). Numeric pain scores were significantly lower in the TEA group (1.7 [1.0–3.2] vs. 2.7 [2.1–4.2]; 1.9 [1.0–3.3] vs. 3.5 [3.5–5.0]; 3.7 [3.0–4.8] vs. 4.2 [3.7–4.7], respectively; p < 0.050). Patients in the TEA group received less opioid administration (4.3 mg vs. 13.9 mg; 7.0 mg vs. 19.9 mg; 10.9 mg vs. 16.5 mg, respectively; p < 0.050). The two groups of patients were detected with no significant difference in the incidence of respiratory depression. Discussion. According to the study results, perioperative stress response was reduced with TEA being added to the anesthesia protocol. Patients in the TEA group received lower doses of analgesics. Both groups produced similar short-term postoperative outcomes. Conclusion. As compared to opioid-based MMA, TEA provided more effective analgesia and similar side effect profiles. Therefore, TEA appears to be an acceptable method for stress response suppression and pain management in patients undergoing robotic-assisted PE.

Stress Response and Analgesia During and after Robotic-Assisted Pelvic Exenteration

Introduction. Thoracic epidural analgesia or thoracic epidural anaesthesia (TEA) and opioid-based intravenous multimodal analgesia (MMA) provide adequate control of perioperative pain, however, comparative data are still to be gathered. Aim. To compare both anesthesia techniques in terms of stress response during and after robotic-assisted pelvic exenteration (PE). Materials and methods. 112 patients were divided into 2 equal groups A level of serum cortisol was measured at induction of anesthesia and in 2, 24, and 48 hours. The efficacy of analgesia was compared using a 10-point numeric pain scale. Analgesic administration and side effects were reported for 1–3 postoperative days. Results. Cortisol levels increased 2 hours after skin incision in the MMA group and only in 24 hours in the TEA group (p < 0.050). Postoperative cortisol levels were significantly lower in the TEA group (p = 0.001). Numeric pain scores were significantly lower in the TEA group (1.7 [1.0–3.2] vs. 2.7 [2.1–4.2]; 1.9 [1.0–3.3] vs. 3.5 [3.5–5.0]; 3.7 [3.0–4.8] vs. 4.2 [3.7–4.7], respectively; p < 0.050). Patients in the TEA group received less opioid administration (4.3 mg vs. 13.9 mg; 7.0 mg vs. 19.9 mg; 10.9 mg vs. 16.5 mg, respectively; p < 0.050). The two groups of patients were detected with no significant difference in the incidence of respiratory depression. Discussion. According to the study results, perioperative stress response was reduced with TEA being added to the anesthesia protocol. Patients in the TEA group received lower doses of analgesics. Both groups produced similar short-term postoperative outcomes. Conclusion. As compared to opioid-based MMA, TEA provided more effective analgesia and similar side effect profiles. Therefore, TEA appears to be an acceptable method for stress response suppression and pain management in patients undergoing robotic-assisted PE.

Effects of buccal acupuncture on postoperative analgesia in elderly patients undergoing laparoscopic radical gastrectomy: a randomized controlled trial.

This study aimed to evaluate the efficacy and safety of buccal acupuncture on postoperative analgesia, perioperative stress response and adverse events in elderly patients undergoing laparoscopic radical gastrectomy. It was a prospective, outcome assessor-blinded, randomized controlled trial, involving 90 patients aged 65-80 years who were treated with an elective laparoscopic radical gastrectomy. They were randomly assigned to buccal acupuncture group (Group B) and control group (Group C). Buccal acupuncture was applied to patients of Group B before the induction of general anesthesia, while no additional application was given to those in Group C. Patient-controlled intravenous analgesia (PCIA) with sufentanil was postoperatively performed in both groups. Sufentanil consumption and the Visual Analog Scale (VAS) score within 48 h postoperatively were assessed as primary outcomes. Secondary outcomes included peripheral levels of stress markers, intraoperative consumptions of anesthetic drugs and postoperative recovery. Patients in Group B presented significantly lower VAS scores within 24 h and less consumption of sufentanil within 48 h postoperatively (both p < 0.01). The awaking time, time to extubation and length of stay were significantly shorter in Group B than in Group C (p = 0.005, 0.001 and 0.028, respectively). Compared with Group C, stress response and inflammatory response within 24 h postoperatively were also significantly milder in Group B. The use of buccal acupuncture before general anesthesia induction favors the postoperative analgesic effect and recovery in elderly patients undergoing laparoscopic radical gastrectomy, the mechanism of which involves relieving postoperative stress response and inflammatory response. This study was registered in the Chinese Clinical Trial Registry (www.chictr.org.cn) on 15/06/2023 (ChiCTR2300072500).

The Effect of Different Anesthesia Depths on Postoperative Cognitive Function of Tumor Patients Monitored by Narcotrend

Abstract Objectives The study aimed to examine the influence of different anesthesia depths monitored by Narcotrend on postoperative cognitive dysfunction (POCD) in elderly patients undergoing radical resection of gastrointestinal malignancies. Methods Individuals in the control group (n = 40) maintained the Narcotrend index (NTI) at 50 to 59 monitored by Narcotrend, whereas the experimental group at 30 to 39. The mini-mental state examination (MMSE) scale and serum S100β concentration were used to evaluate the cognitive function. Cerebral oxygen metabolism and inflammation were evaluated, presenting as regional oxygen saturations of brain (rSO2) and cerebral oxygen uptake rate (CERO2), serum tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6). Results Experimental group presented prominently high levels of rSO2 and low levels of CERO2 relative to controls, meanwhile with reduced serum TNF-α and IL-6. Individuals receiving deep anesthesia owned low levels of S100β and enhanced MMSE score, which showed negative correlation. Low incidence rate of POCD was detected in the experimental group. Both age (hazard ratio = 5.219, 95% confidence interval = 1.813–15.025) and NTI score (hazard ratio = 3.707, 95% confidence interval = 1.292–10.633) were independent influence factors for the onset of POCD. Conclusion NTI maintained at 30 to 39 can reduce the incidence of POCD in the early postoperative period for elderly patients receiving gastrointestinal tumors surgery, the contribution might be attributed to the improvement of perioperative cerebral oxygen metabolism and inflammatory stress response.

Sex Differences in Outcomes of Hepatobiliary and Pancreatic Surgery with Accelerated Rehabilitation.

Sex, in the sense of gender, is a major social demographic characteristic that has been shown to affect health care outcomes. The concept of enhanced recovery after surgery (ERAS) is an effective perioperative management measure that can reduce the perioperative stress response in patients. However, there are few studies on the differences between male and female patients under this type of care. We aimed to analyze sex differences in clinical characteristics among patients undergoing hepatobiliary and pancreatic surgery with accelerated rehabilitation. We enrolled patients who underwent liver, biliary tract, and gallbladder operations in the Department of Hepatobiliary and Pancreatic Surgery of Taizhou Hospital, Zhejiang Province, China, from April 2021 to July 2021. Key measures were collected for patients undergoing perioperative accelerated rehabilitation (i.e., the case group). The study group was assembled by performing 1:1 matching for age, sex, chronic disease, and type of surgery. Postoperative risk assessment, postoperative recovery indicators, and postoperative length of hospital stay (days) were compared between male and female patients. A total of 226 surgical patients were enrolled, including 109 male (48.23%) and 117 female patients (51.77%). The outcomes, presented as the median (min, max), were as follows: pulmonary rehabilitation risk assessment in females (1(0,3)) and males (0(0,2)), postoperative nausea and vomiting in females (2(1,3)) and males (1(0,2)), and time to first defecation in females (31(4,61)) and males (36(10,78)). Significant differences were indicated by p values < 0.05. We identified sex differences in the clinical prognosis and performance of perioperative patients undergoing hepatobiliary and pancreatic surgery with accelerated rehabilitation. The perioperative pulmonary rehabilitation risk of male patients was higher than that of female patients, and the time to first defecation was longer in male than in female patients. The incidence of nausea and vomiting in women was higher than in men.

Monitoring Blood Glucose as a Perioperative Stress Response Marker and the Effect of Dexmedetomidine Premedication in Laparoscopic Surgery Patients: A Randomised Controlled Study

Introduction: Perioperative stress increases cortisol levels, which in turn elevates glucose production. Thus, regular monitoring of glucose during the perioperative period can predict intraoperative stress and the depth of anaesthesia. Dexmedetomidine (Dex) is used as an adjunct during anaesthesia to attenuate the pressor response during tracheal intubation. Aim: To assess sequential blood sugar values in Dex-mediated attenuation of the perioperative neuroendocrine stress response. Materials and Methods: A randomised, controlled, double-blinded study was conducted at the Department of Anaesthesiology, M.K.C.G Medical College and Hospital, Berhampur, Odisha, India on 80 patients undergoing laparoscopic surgery, divided into two groups (n=40). Group-I was administered 50 mL of Normal saline i.v. over 10 minutes, whereas Group-II received Dex 1 mcg/kg in 0.9% normal saline diluted to 50 mL over 10 minutes i.v.. Blood glucose levels and haemodynamic parameters such as Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Heart Rate (HR) were evaluated in the preoperative room, 30 minutes after surgical incision, after extubation, one hour after surgery, and 2.5 hours following surgery. Unpaired Student’s t-test was used to compare the variables at different time points. Results: There was no significant difference in age (48.58±5.89 and 46.25±6.51 years; p&gt;0.05), weight (57.07±7.84 and 56.8±7.4 kg; p&gt;0.05), and American Society of Anaesthesiologists (ASA) status among the Group-I and Group-II patients. Female preponderance was observed, but it was not significant between Group-I and Group-II patients (27 vs 31; p&gt;0.05). In Group-II, Dex-administered patients, the mean blood sugar levels at 30 minutes past surgical incision, after extubation, one hour, and 2.5 hours following surgery were 104.35±13.58, 97.15±5.86, 98.4±7.45, 94.08±7.37 mg/dL, respectively. This was lower when compared to Group-I saline-treated patients, 135.95±14.4, 137.38±7.93, 138.08±8.84, and 137.70±15.13 mg/dL, and was found to be significant (p&lt;0.05). Conclusion: Serial blood glucose estimation can be a useful marker to evaluate the perioperative neuroendocrine response. Dex premedication has effectively modulated the neuroendocrine stress response during anaesthesia.

Molecular mechanisms of electropuncture in cerebrovascular protection during enhanced recovery after surgery period

The core intent of enhanced recovery after surgery (ERAS) is to alleviate the perioperative stress response and postoperative complications through perioperative multimodal analgesia and intensive surgery. Previous studies have demonstrated that multiple molecular mechanisms function in improving ischemic stroke, reversing the process of ischemia reperfusion, relieving intracerebral hemorrhage and traumatic brain injury. Meanwhile, electroacupuncture (EA) has been validated with regard to its efficacy and safety in perioperative treatment, which has an important impact on rehabilitation research and ERAS development. Currently, studies have showed that EA provides a new approach for cerebrovascular protection by activating various molecular mechanisms. In this review, we display the recent progress of main molecular mechanisms of EA in ERAS from the perspectives of protecting cerebrovascular functions, in order to provide guidance for the clinical treatment.

The effect of spinal versus general anaesthesia on perioperative muscle weakness in patients having bilateral total hip arthroplasty: a single center randomized clinical trial

BackgroundPerioperative neuro-endocrine stress response may contribute to acquired muscle weakness. Regional anaesthesia has been reported to improve the outcome of patients having total hip arthroplasty. In this study, it was hypothesized that spinal anaesthesia (SA) decreases the perioperative neuro-endocrine stress response and perioperatively acquired muscle weakness (PAMW), as compared to general anaesthesia (GA).MethodsFifty subjects undergoing bilateral total hip arthroplasty (THA) were randomly allocated to receive a standardized SA (n = 25) or GA (n = 25). Handgrip strength was assessed preoperatively, on the first postoperative day (primary endpoint) and on day 7 and 28. Respiratory muscle strength was measured by maximal inspiratory pressure (MIP). Stress response was assessed by measuring levels of Adrenocorticotropic hormone (ACTH), cortisol and interleukin-6 (IL-6).ResultsHandgrip strength postoperatively (day 1) decreased by 5.4 ± 15.9% in the SA group, versus 15.2 ± 11.7% in the GA group (p = 0.02). The handgrip strength returned to baseline at day 7 and did not differ between groups at day 28. MIP increased postoperatively in patients randomized to SA by 11.7 ± 48.3%, whereas it decreased in GA by 12.2 ± 19.9% (p = 0.04). On day 7, MIP increased in both groups, but more in the SA (49.0 ± 47.8%) than in the GA group (14.2 ± 32.1%) (p = 0.006). Postoperatively, the levels of ACTH, cortisol and IL-6 increased in the GA, but not in the SA group (p < 0.004).ConclusionIn patients having bilateral THA, SA preserved the postoperative respiratory and peripheral muscle strength and attenuated the neuro-endocrine and inflammatory responses.Trial registration: clinicaltrials.gov NCT03600454.

Effect of perioperative acupoint electrical stimulation on macrophages in mice under operative stress

The strong perioperative stress response caused by surgical anesthesia can significantly suppress immune function, and the body is in a state of immunosuppression for 3 to 4 days after surgery, which leads to an increase in the probability of postoperative infection. Traditional Chinese medicine believes that acupuncture points can "reconcile yin and yang", promote the recovery of immune function, and help reduce the incidence of postoperative infection. Macrophages are an important type of immune cells that participate in the body's innate immunity. They have powerful phagocytosis and clearance functions. They can be polarized into M1 and M2 types under the regulation of the body, and play different roles in fighting microbial infections. Among them, the M1 type can participate in the elimination of pathogens. In this study, we will investigate the perioperative acupoint electrical stimulation to alleviate the immunosuppressive state of surgical stress mice, clarify the regulation of perioperative acupoint electrical stimulation on glucocorticoids and the relationship between NF-κB molecules and macrophage polarization.The key molecules of related pathways were verified by glucocorticoid receptor inhibitors, and it was found that electrical stimulation of acupoints during the perioperative period can affect the polarization of macrophages in surgically stressed mice to the M1 type by reducing the level of glucocorticoids and promoting the expression of NF κB molecules. Further reveal the partial mechanism of electroacupuncture regulating the anti-inflammatory and pro-inflammatory processes of macrophages in the immune response.

Effect of analgesia nociception index monitor-based nociception control on perioperative stress responses during laparoscopic surgery in Trendelenburg position: a randomized controlled trial.

The analgesia nociception index (ANI) monitor is a nociception monitoring device based on heart rate variability. We aimed to determine the effect of ANI monitor-based intraoperative nociception control on the perioperative stress response during laparoscopic surgery in the Trendelenburg position. Altogether, 72 female patients who underwent total laparoscopic hysterectomy were randomized to either the control or ANI group. Intraoperative nociception was controlled by remifentanil administration in a conventional manner (based on blood pressure and heart rate) in the control group and by ANI monitoring in the ANI group. Perioperative stress responses were estimated by measuring the levels of serum catecholamines and catabolic stress hormones at three timepoints: after loss of consciousness, at the end of surgery, and 1 h after the end of surgery. The serum cortisol level at the end of surgery was significantly higher in the ANI group than in the control group (p < 0.001), although more remifentanil was administered in the ANI group than in the control group (p < 0.001). Changes in the other estimators' levels were comparable between groups during the perioperative period. The hemodynamic profiles during surgery were also significantly different between the two groups. Phenylephrine use to treat hypotension was more common in the ANI group than in the control group (p = 0.005). However, postoperative clinical outcomes such as pain and nausea/vomiting did not differ between groups. ANI monitor-based nociception control in laparoscopic surgery in the Trendelenburg position did not improve perioperative stress responses, intraoperative opioid consumption, or postoperative clinical outcomes.Clinical trial registration: ClinicalTrials.gov (NCT04343638).

Molecular mechanism of electroacupuncture for improving perioperative complications with the guidance of enhanced recovery after surgery

Enhanced recovery after surgery (ERAS) is a recommended surgical strategy at present, the core content is to reduce perioperative stress response and postoperative complications through perioperative multi-mode analgesia and intensive surgery. Electroacupuncture (EA) has been widely used in various clinical applications, and its efficacy and safety have been fully proven. The application of acupuncture in ERAS will have an important impact on rehabilitation research and development. In this review, the molecular mechanism of EA in ERAS are summed up from promoting perioperative efficacy to improving postoperative immune status. The combination of EA and ERAS may better promote the recovery of patients and the development of rehabilitation.

Assessing and reducing severity of perioperative stress response to emergency surgery in patients with acute cholecystitis

Assessing and reducing severity of perioperative stress response to emergency surgery in patients with acute cholecystitis

Clinical application of electroacupuncture in enhanced recovery after surgery.

Enhanced recovery after surgery (ERAS) is currently the recommended surgical strategy, the main content of which is to reduce perioperative stress response and postoperative complications through perioperative multimodal analgesia and intensive surgery. Since ERAS was introduced, many rehabilitation medicine teams have been deeply involved, including physical therapy, occupational therapy, nutrition therapy and psychological counseling. However, ERAS lacks several powerful means to address perioperative prognostic issues. Therefore, how to further improve the effects of ERAS, reduce perioperative complications and protect vital organ functions has become an urgent problem. With the continuous development of traditional Chinese medicine, electroacupuncture (EA) has been widely used in various clinical applications, and its efficacy and safety have been fully proved. Recent studies have shown that the application of EA in ERAS has had an important impact on rehabilitation researches. In terms of reducing complications, the therapeutic effects of EA treatment mainly include: reducing pain and the use of analgesics; Improvement of postoperative nausea and vomiting; Postoperative immune function treatment; Relieve anxiety and depression. In addition, EA also protects the recovery of physiological functions, including cardiovascular function, cerebrovascular function and gastrointestinal function, etc. To sum up, the complementary strengths of EA and ERAS will allow them to develop and combine. This review discusses the potential value and feasibility of EA in ERAS from the aspects of improving perioperative efficacy and protecting organ functions.

A Quest for Enhanced Recovery After Liver Transplant at The Colombo North Center for Liver Disease: The First Decade

Cirrhosis is a significant contributor to non-communicable disease related deaths in Sri Lanka and the only cure for cirrhosis constitutes liver transplant. Nonalcoholic fatty liver disease (NAFLD) which is the hepatic component of the metabolic syndrome is the main aetiology of cirrhosis in patients presenting for liver transplant at CNCLD. Enhanced recovery after surgery (ERAS) is a concept originally adopted in colorectal surgery, and is a multimodal- multidisciplinary approach to perioperative care aiming to reduce perioperative surgical stress response and improve short-term outcome. Targeting improved outcome, components of ERAS have been incorporated in the perioperative care of liver transplant at the Colombo North Center for Liver Disease since 2016. Sri Lanka needs to define its own enhanced recovery after liver transplant (ERALT) protocols based on local data and audit performance.

Clinical effect of laparoscopic cholecystectomy in the treatment of chronic cholecystitis with gallstones

ABSTRACT Chronic cholecystitis is a common disease that causes inflammation in the gallbladder and is usually associated with gallstones. Laparoscopic cholecystectomy has been widely used as a minimally invasive surgical technique to treat this condition. However, the clinical effect of laparoscopic cholecystectomy in the treatment of chronic cholecystitis with gallstones needs further investigation. This study aimed to investigate the clinical effect of laparoscopic cholecystectomy in treating chronic cholecystitis with gallstones. 90 patients with chronic cholecystitis and gallstones were randomly divided into control and research groups. The control group underwent traditional open cholecystectomy, while the research group received laparoscopic cholecystectomy. Perioperative indexes, oxidative stress indexes, serum inflammatory factors, liver function indexes and the incidence of complications were observed and compared. Results showed that laparoscopic cholecystectomy significantly reduced the operation time, blood loss, anal exhaust time, abdominal pain duration, and hospital stay compared to traditional open cholecystectomy (P < 0.05). Moreover, laparoscopic cholecystectomy significantly reduced the levels of oxidative stress indexes (GSH-Px), inflammatory factors (IL-6, TNF-α, and CRP), and liver function indexes (TBIL, AST, and ALT) compared to traditional open cholecystectomy. Moreover, the complication rate of the research group was significantly lower than that of the control group (P < 0.05). In conclusion, laparoscopic cholecystectomy for chronic cholecystitis with gallstones is a safe and effective procedure that reduces the perioperative stress response and promotes the rapid recovery of the postoperative body. The findings of this study provide a basis for the clinical promotion of laparoscopic cholecystectomy as the preferred surgical treatment for chronic cholecystitis with gallstones.

Enhanced recovery after surgery (ERAS) relieves psychological stress in patients with osteoporotic vertebral compression fracture undergoing percutaneous kyphoplasty: an observational retrospective cohort study

Study designThis is an observational retrospective cohort study.ObjectiveThe purpose of this study is to investigate the incidence rate of depression and anxiety and the changes in patients treated with percutaneous kyphoplasty (PKP) following ERAS protocol.Summary of background dataThe incidence of depression and anxiety is not uncommon in patients with osteoporotic vertebral compression fracture (OVCF), which affects the prognosis of surgery. Enhanced recovery after surgery (ERAS) protocols can improve the perioperative stress response of patients.Materials and methodsPatients were treated conventionally in 2019 as the control group (CG) (n = 281), and patients were treated according to the ERAS protocol in 2020 as the intervention group (IG) (n = 251). All patients were evaluated for depression and anxiety using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 at admission, postoperative 1 week, 1 month and 3, 6, 12 months.ResultsThe degree of depression statistically decreased in the IG at follow-up periods (p < 0.001), and the degree of anxiety statistically decreased at 1 week (p < 0.001), 1 month (p < 0.001), 3 months (p = 0.017). Patients in the IG could soothe depression and anxiety disorders faster than patients in the CG and maintain psychological stability at the follow-up periods. The percentage of moderate or above depression in the IG was statistically fewer than in the CG at follow-up periods (p < 0.01). The odds ratio (OR) was respectively 0.410, 0.357, 0.294, 0.333, 0.327 from 1 week to 12 months. While the percentage of patients with moderate or above anxiety significantly decreased in the IG at 1 week (p < 0.001), OR = 0.528, 1 month (p = 0.037), OR = 0.309 and 12 months (p = 0.040), OR = 0.554, no differences between 3 months (p = 0.187) and 6 months (p = 0.133).ConclusionPKP following ERAS protocol to treat patients with OVCF had a better effect on relieving postoperative anxiety and depression than following conventional protocol.

Impact of humanized care on perioperative stress response and complications of burn-injured patients.

Impact of humanized care on perioperative stress response and complications of burn-injured patients.

Effects of electroacupuncture on perioperative anxiety and stress response in patients undergoing surgery for gastric or colorectal cancer: Study protocol for a randomized controlled trial.

Perioperative anxiety is one of the main psychological stresses experienced by patients who undergo cancer surgery. The surgery itself inevitably causes a stress response characterized by activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis. Both the perioperative anxiety and surgical stress response lead to increased levels of catecholamines and prostaglandins, which may be related to perioperative suppression of antimetastatic immunity and tumor-promoting alterations in the microenvironment. Hence, we designed this clinical trial to investigate the effect of electroacupuncture in reducing perioperative anxiety and surgical stress response. This is a randomized, single-center, parallel, and controlled clinical trial. Seventy-eight participants between the ages of 35 and 85 with gastric or colorectal cancer who plan to undergo tumorectomy will be randomly divided into an electroacupuncture group and a control group. The primary outcome will be the six-item short form of the State-Trait Anxiety Inventory score. The secondary outcomes will be the Amsterdam Preoperative Anxiety and Information Scale score; levels of plasma cortisol, adrenocorticotropic hormone, interleukin-6, and tumor necrosis factor-α; first exhaust time after surgery; postoperative quality of the recovery-15 score, numeric rating scale for pain score; and dosage of postoperative analgesics. Cumulative studies revealed the efficacy of various types of acupuncture therapy with regard to reducing the anxiety and stress response caused by surgery. We expect that the results of this trial will provide high-quality clinical evidence for the choice of perioperative acupuncture for patients undergoing cancer surgery. https://www.chictr.org.cn, identifier ChiCTR200003 7127.

Assessment on Perioperative Outcome of Epidural Anesthesia &amp; Analgesia

Introduction: Epidural anesthesia and analgesia have the potential to reduce or eliminate the perioperative physiologic stress responses to surgery and thereby decrease surgical complications and improve outcomes. This study aimed to integrate experimental and clinical data addressing the physiologic effects of epidural anesthesia and postoperative epidural analgesia on surgical patients and to review the real and potential benefits of this technology concerning patient outcomes. Methods: This prospective observational study was conducted at the Department of Anesthesia, Upazilla Health Complex, Daganbhuiya, Feni, Bangladesh. The study was carried out from June 2020 to July 2021. A total of 110 patients were selected as study subjects as per inclusion criteria. Result: Out of 110 study subjects 20 (18.19%) subjects were in the 25-30 years age group, 30 (27.27%) were in the 31-35 years age group and the rest 60 (54.54%) were in &gt;35 years, age group. Regarding the region of surgery done, 50% of subjects underwent lower abdominal surgery, 20% underwent surgery of lower extremities, 15% underwent labor pain, and the rest 15% underwent cardiothoracic surgery. Concerning intraoperative complication, hypotension was predominant which constituted 9% of total study subjects followed by nausea &amp; vomiting seen in 3% of patients. 2.5% of patients had bradycardia, 2% experienced hypertension, only 1% of patients had tachycardia, and none experienced poor anesthesia. In terms of postoperative complications, post-dural puncture headache was predominant which was seen in 4% of patients, 2% had prolonged ICU stay, 2% had cardiopulmonary complications, 1% had postoperative pain, and 1% experienced occlusion of catheter and catheter fragment retention. It was seen that 95.5% of total patients did not need ephedrine or atropine, only 2% of patients needed ephedrine during the operation due to hypotension and 2.5% needed atropine during the operation due to bradycardia. Regarding the advantages of epidural anesthesia, reduced ileus was seen in 105 (95.45%) patients, reduced length of hospital stay in 108 (98.18%) patients, and reduced 30-day morbidity and mortality in 110 (100%) patients. The overall surgical outcome was excellent as well. In 98% of cases, the surgical outcome was satisfactory and only 2% showed poor surgical outcome. Conclusion: The effect of anesthetic and postoperative analgesic techniques on perioperative outcomes varies with the type of operation performed. Overall, epidural analgesia provides better postoperative pain relief and surgical outcomes.

Long-term effect of anesthesia choice on patients with hepatocellular carcinoma undergoing open liver resection.

Clinical and experimental evidence suggested that anesthesia choice can influence cancer progression and patients' outcomes by modulating tumor microenvironment and tumorigenic pathways. Curative resection is the mainstay of therapy for hepatocellular carcinoma (HCC), which is an intractable disease due to high recurrence and poor prognosis. However, different anesthetics may play different roles in alleviating surgery-induced stress response and inflammatory cytokines release that are considered to be closely associated with proliferation, invasion and metastasis of tumor cells. Propofol, sevoflurane, non-steroidal anti-inflammatory drugs and local anesthetics have shown to exert anti-tumor effect on HCC mainly through regulating microRNAs or signaling pathways, while other inhalational agents, dexmedetomidine and opioids have the potential to promote tumor growth. In terms of anesthetic methods and analgesia strategies, propofol based total intravenous anesthesia and thoracic epidural analgesia could be preferred for HCC patients undergoing open liver resection rather than inhalational anesthesia. Local anesthesia techniques have great potential to attenuate perioperative stress response, hence they may contribute to more favorable outcomes. This review summarized the relations between different anesthesia choices and HCC patients' long-term outcomes as well as their underlying mechanisms. Due to the complexity of molecules interactions and signaling pathways, further studies are warranted to confirm these results so as to optimize anesthesia strategy for HCC patients.