Perioperative Stress Response Research Articles

A comparative study of clonidine and magnesium sulfate premedication on perioperative hormonal stress responses, hemodynamic stability and postoperative analgesia in patients with gallbladder diseases undergoing laparoscopic cholecystectomy. A randomized, double-blind, controlled study

ABSTRACT Background Hemodynamic derangement due to pneumoperitoneum and postoperative pain after laparoscopic cholecystectomy can be detrimental; this study investigated whether preoperative intravenous (I.V.) infusion of clonidine or Magnesium Sulfate (MgSO4) could attenuate hemodynamic responses, reduce serum cortisol level and improve post-operative analgesia. Materials and Methods In total, 105 patients scheduled for laparoscopic cholecystectomy were randomized to either group C (I.V. infusion of clonidine 1.5 µg/kg), group M (I.V.infusion of MgSO2 30 mg/kg) or group S (I.V. infusion of isotonic saline) 15 min before induction of general anesthesia. Outcome variables were heart rate (H.R.), mean arterial pressure (MAP), serum cortisol leveln, total analgesic requirements and recovery time. Results HR was significantly lower in group C than that in groups M and S. MAP and serum cortisol were significantly lower in groups C and M than that in control group. Pain score was better in groups C and M than group S at the first 2 hours post-operative with (P values 0.024 and 0.19), respectively. Reduced post-operative analgesic requirement with delayed onset to first analgesic request were observed in groups C and M compared with the control group . Recovery time was significantly rapid in group C than that of groups M and S. Conclusion Pre-operative I.V. infusion of clonidine and MgSO4 significantly attenuated the hemodynamic response to pneumoperitoneum, reduced serum cortisol level, reduced postoperative pain and analgesic requirement as compared to controls in patients undergoing laparoscopic cholecystectomy. Clonidine was superior compared to MgSO4 regarding H.R. control and rapid recovery.

Self-assessment questions

Enhanced Recovery Programmes (ERPs) utilize multiple interventions derived from available research evidence to mitigate the perioperative physiological stress response and preserve anabolic homeostasis. Which of the measures below is a common element of ERPs?A.Fasting for at least 6 hours including clear fluids to help bowel preparationB.Avoidance of intra- abdominal drains and vaginal packC.Routine use of IV opioids to control postoperative painD.Delayed removal of urinary catheterE.All of the above

Effect of general anesthesia with thoracic paravertebral block on postoperative delirium in elderly patients undergoing thoracoscopic lobectomy: a randomized-controlled trial

BackgroundPostoperative delirium (POD) is characterized by acute brain dysfunction, especially in elderly patients. Postoperative pain is an important factor in the development of delirium, and effective pain management can reduce the risk of POD. Thoracic paravertebral block (TPVB) can effectively relieve postoperative pain and inhibit the perioperative stress and inflammatory response. We investigated whether the combination of TPVB with general anesthesia reduced the occurrence of POD following thoracoscopic lobectomy.MethodsA total of 338 elderly patients, aged 65–80 years, who underwent elective surgery for video-assisted thoracoscopic lobectomy (VATS) were randomly assigned to either a patient-controlled intravenous analgesia group (PIA) or a patient-controlled paravertebral-block analgesia group (PBA). POD was evaluated using the 3-min diagnostic confusion assessment method (3D-CAM). The postoperative quality of recovery (QoR) was assessed with Chinese version of QoR-40 scale. Pain intensity was measured using the visual analog scale (VAS) score. Tumor necrosis factor-α (TNF-α) and neurofilament light (NFL) levels were determined using enzyme-linked immunosorbent assay (ELISA) kits.ResultsDelirium occurred in 47 (28%) of 168 cases in the PIA group and 28 (16.5%) of 170 cases in the PBA group (RR 1.7, p = 0.03). PBA was also associated with a higher rate of overall recovery quality at day 7 after surgery (27.1% vs. 17.3%, P = 0.013) compared with PIA. The incremental change in surgery-induced TNF-α and NFL was greater in the PIA group than PBA group (p < 0.05).ConclusionThoracic paravertebral block analgesia is associated with lower incidence of postoperative delirium, probably due to its anti-neuroinflammatory effects. Furthermore, as a component of multimodal analgesia, TPVB provides not only superior analgesic but also opioid-sparing effects.Trial registrationThe study was registered on the Chinese Clinical Trial Registry Center (www.chictr.org.cn; registration number: ChiCTR 2,000,033,238) on 25/05/2018.

Can Acute Postoperative Pain Management After Tumour Resection Surgery Modulate Risk of Later Recurrence or Metastasis?

BackgroundCancer is a leading cause of mortality worldwide, but death is rarely from the primary tumour: Rather it is multi-organ dysfunction from metastatic disease that is responsible for up to 90% of cancer-related deaths. Surgical resection of the primary tumour is indicated in 70% of cases. The perioperative stress response, tissue hypoxia at the site of surgery, and acute pain contribute to immunosuppression and neo-angiogenesis, potentially promoting tumour survival, proliferation, and metastasis. Poorly controlled acute postoperative pain decreases Natural Killer (NK) immune cell activity, which could potentially facilitate circulating tumour cells from evading immune detection. This consequently promotes tumour growth and distal metastasis.MethodsWe conducted a comprehensive literature search for links between acute pain and cancer outcomes using multiple online databases. Relevant articles from January 1st, 2010 to September 1st, 2021 were analysed and appraised on whether postoperative pain control can modulate the risk of recurrence, metastasis, and overall cancer survival.ResultsAlthough experimental and retrospective clinical data suggest a plausible role for regional anaesthesia in cancer outcome modulation, this has not been supported by the single, largest prospective trial to date concerning breast cancer. While there are mixed results on anaesthesiology drug-related interventions, the most plausible data relates to total intravenous anaesthesia with propofol, and to systemic administration of lidocaine.ConclusionThe hypothesis that anaesthetic and analgesic technique during cancer surgery could influence risk of subsequent recurrence or metastasis has been prevalent for >15 years. The first, large-scale definitive trial among women with breast cancer found robust equivalent findings between volatile anaesthesia with opioid analgesia and regional anaesthesia. Therefore, while regional anaesthesia during tumour resection does not seem to have any effect on cancer outcomes, it remains plausible that other anaesthetic techniques (e.g. total intravenous anaesthesia and systemic lidocaine infusion) might influence oncologic outcome in other major tumour resection surgery (e.g. colorectal and lung). Therefore, another large trial is needed to definitively answer these specific research questions. Until such evidence is available, perioperative analgesia for cancer surgery of curative intent should be based on patient co-morbidity and non-cancer endpoints, such as optimising analgesia and minimising postoperative complications.

Influence of Deep Neuromuscular Blockade on Perioperative Stress Response in Patients Undergoing Robot-Assisted Gastrectomy: A Prospective Double-Blinded Randomized-Controlled Trial.

Attenuating the intraoperative stress response is crucial; however, the effect of neuromuscular blockade (NMB) on surgical stress is not completely understood. We aimed to investigate the effects of NMB on the perioperative stress response during robot-assisted gastrectomy. Patients were assigned to the deep or moderate NMB group. Serum cortisol, prolactin, and interleukin-6 (IL-6) levels and natural killer (NK) cell percentage were measured before anesthesia induction, 90 min after pneumoperitoneum, operation end (OPEnd), and postoperative day 1. Additionally, C-reactive protein (CRP) and albumin levels were estimated. Additionally, intraoperative heart rate variability was evaluated. The deep NMB group showed significantly lower levels of low-frequency/high-frequency (HF) ratio at OPEnd compared to the moderate NMB group (1.4 ± 0.2 vs. 2.2 ± 0.3, respectively; Bonferroni corrected p = 0.039). Furthermore, HF power in the deep NMB group was significantly higher at OPEnd than that in the moderate NMB group (45.2 ± 3.6 vs. 33.8 ± 4.0, respectively; Bonferroni corrected p = 0.044). However, no significant differences in cortisol, prolactin, IL-6, CRP, and albumin levels and NK cell percentage were found between the two groups. The degree of NMB may have similar effects on stress-related biological markers in patients undergoing robot-assisted gastrectomy.

Progress on acupuncture intervention for perioperative stress response

To summarize the application value of acupuncture in perioperative stress response. Perioperative acupuncture can not only effectively relieve pain and stress response during operation, but also relieve psychological stress response represented by preoperative anxiety before operation, and regulate adaptive immune response after operation. Acupuncture, as a safe non-drug therapy, shows its core advantage of participating in the multidisciplinary intervention of enhance recovery after surgery (ERAS). The future studies need to explore and evaluate the role of acupuncture during perioperative period from multiple dimensions, and gradually reveal the mechanism of acupuncture while establishing the evidence-based basis for acupuncture during perioperative period.

Стрес-відповідь при корекції лійкоподібної деформації грудної клітки за Nuss в умовах комбінації загальної анестезії з різними реґіонарними блокадами

The perioperative stress-response is a dynamic process under the influence of patient-specific, surgical and anaesthesiologic factors. Purpose – to evaluate stress response during the correction of pectus excavatum by Nuss under the combination of general anesthesia with different variants of the regional block. Materials and methods. The observative prospective study included 60 adolescents (boys/girls=47/13) undergone Nuss procedure under the combination of general anesthesia and regional blocks. The patients were randomized into three groups (n=20 in each) according to the perioperative regional analgesia technique: standard epidural anesthesia (SEA) in Th5–Th8, high epidural anesthesia (HEA) in Th2–Th3, and bilateral paravertebral anesthesia (PVA) in Th5–Th8. The serum cortisol and glycemia were analyzed at three stages: 1 – baseline before surgery, 2 – during bar rotation, and 3 – after surgery finished. Results. The average serum cortisol level among all patients before surgery was 342.4 [282.1–415.0] nmol/L. At stage 2 the plasma cortisol decreased up to 223.1 [174.9–282.3] nmol/L (p&lt;0.000001). After the surgery and anesthesia finished the average plasma cortisol was 279.6 [216.7–312.6] nmol/L (p&lt;0.000001 vs baseline). During surgery serum cortisol decreased in group SEA by 41%, in group HEA – by 30%, and in group PVA – by 31% compared with baseline levels. After surgery, the serum cortisol was lower than baseline measurements in group SEA by 28%, in group HEA – by 20%, and in group PVA – by 26%. The average baseline glycemia among all patients before surgery was 4.62 [4.01–5.05] mmol/L. At stage 2 glycemia decreased significantly up to 4.05 [3.86–4.62] mmol/L (p=0.00018). After the surgery finished the average serum glucose among all patients was 4.24 [4.09–4.99] mmol/L (p=0.7). At stage 2 serum glucose decreased in group SEA by 11%, in groups HEA and PVA – by 5% compared with the baseline level. The dynamics of serum cortisol and glycemia were similar in all groups with statistically insignificant intergroup differences at all three stages. Conclusions. Serum cortisol and glycemia during the Nuss procedure under the combination of general anesthesia with regional blocks decreased significantly. After surgery finished glycemia returned to baseline level, but serum cortisol was lower than baseline measurement. The changes in serum cortisol and glycemia were more pronounced in patients under standard epidural analgesia in Th5–Th8 compared with the high epidural in Th2–Th3 and paravertebral blocks. The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution. Informed consent of parents and children was obtained for the study. The author declares no conflict of interest. Key words: cortisol, glycaemia, pectus excavatum, Nuss procedure, regional anaesthesia.

Effects of Dexmedetomidine on Perioperative Stress Response and Cellular Immunity in Elderly Patients with Posterior Lumbar Surgery

The aim of this study was to investigate the effects of dexmedetomidine on perioperative stress response and cellular immunity in elderly patients with posterior lumbar surgery. Sixty patients with lumbar degenerative disease requiring posterior lumbar surgery were included and randomly divided into the dexmedetomidine group (the test group, [Formula: see text]) and the control group ([Formula: see text]). After the experimental group entered the room, dexmedetomidine was intravenously pumped 10[Formula: see text]min before induction of anesthesia and dexmedetomidine was continuously pumped after anesthesia. The control group replaced dexmedetomidine with the same amount of normal saline, and the other operations were exactly the same as the experimental group. Hemodynamic parameters were routinely monitored and the percentages of T lymphocyte subsets were analyzed by flow cytometry. Samples for stress response parameters were sent to the Clinical Laboratory of our hospital, and perioperative pain, postoperative adverse reactions and complications were evaluated during the study. The levels of postoperative stress hormones, including noradrenaline (NE), epinephrine (E), cortisol (Cor) and acetylcholine (Ach), were reduced in the test group compared with those in the control group ([Formula: see text]). Proportions of CD3[Formula: see text], CD4[Formula: see text], CD8[Formula: see text] and NK as well as the CD4[Formula: see text]/CD8[Formula: see text] in the control group were significantly decreased at postoperative Day 1 (T6), Day 3 (T7) and Day 7 (T8) compared with those at preoperative Day 1 (T-1) ([Formula: see text]), while the proportions of CD4[Formula: see text] and NK in the test group were significantly increased at T6, T7 and T8 compared with those at T-1 ([Formula: see text]). The mean arterial pressure (MAP) of the test group was decreased compared with that of the control group at each time point ([Formula: see text]). After the operation, the heart rate (HR) of the patients in the test group was significantly decreased compared with the control group ([Formula: see text]) and the VAS score of the control group were increased compared with the test group at each time point ([Formula: see text]). Dexmedetomidine can decrease the stress response and improve postoperative cellular immune function in patients with posterior lumbar surgery by reducing postoperative stress hormones to alleviate the postoperative cellular immunosuppression and the pain in patients.

Evaluation of the perioperative stress response from dexmedetomidine infusion alone, with butorphanol bolus or remifentanil infusion compared with ketamine and morphine infusions in isoflurane-anesthetized horses

ObjectiveTo evaluate perioperative stress-related hormones in isoflurane-anesthetized horses administered infusions of dexmedetomidine alone or with butorphanol or remifentanil, compared with ketamine–morphine. Study designRandomized, prospective, nonblinded clinical study. AnimalsA total of 51 horses undergoing elective surgical procedures. MethodsHorses were premedicated with xylazine, anesthesia induced with ketamine–diazepam and maintained with isoflurane and one of four intravenous infusions. Partial intravenous anesthesia (PIVA) was achieved with dexmedetomidine (1.0 μg kg–1 hour–1; group D; 12 horses); dexmedetomidine (1.0 μg kg–1 hour–1) and butorphanol bolus (0.05 mg kg–1; group DB; 13 horses); dexmedetomidine (1.0 μg kg–1 hour–1) and remifentanil (3.0 μg kg–1 hour–1; group DR; 13 horses); or ketamine (0.6 mg kg–1 hour–1) and morphine (0.15 mg kg–1, 0.1 mg kg–1 hour–1; group KM; 13 horses). Infusions were started postinduction; butorphanol bolus was administered 10 minutes before starting surgery. Blood was collected before drugs were administered (baseline), 10 minutes after ketamine–diazepam, every 30 minutes during surgery and 1 hour after standing. Mean arterial pressure (MAP), pulse rate, end-tidal isoflurane concentration, cortisol, nonesterified fatty acids (NEFA), glucose and insulin concentrations were compared using linear mixed models. Significance was assumed when p < 0.05. ResultsWithin D, cortisol was lower at 120–180 minutes from starting surgery compared with baseline. Cortisol was higher in KM than in D at 60 minutes from starting surgery. Within all groups, glucose was higher postinduction (except DR) and 60 minutes from starting surgery, and insulin was lower during anesthesia and higher after standing compared with baseline. After standing, NEFA were higher in KM than in DB. In KM, MAP increased at 40–60 minutes from starting surgery compared with 30 minutes postinduction. Conclusions and clinical relevanceDexmedetomidine suppressed cortisol release more than dexmedetomidine–opioid and ketamine–morphine infusions. Ketamine–morphine PIVA might increase catecholamine activity.

The effect of anesthesia on the magnitude of the postoperative systemic inflammatory response in patients undergoing elective surgery for colorectal cancer in the context of an enhanced recovery pathway: A prospective cohort study.

There are reports that the use of regional anesthesia (RA) may be associated with better perioperative surgical stress response in cancer patients compared with general anesthetics (GA). However, the role of anesthesia on the magnitude of the postoperative systemic inflammatory response (SIR) in colorectal cancer patients, within an enhanced recovery pathway (ERP), is not clear.The aim of the present study was to examine the effect of anesthesia, within an enhanced recovery pathway, on the magnitude of the postoperative SIR in patients undergoing elective surgery for colorectal cancer.Database of 507 patients who underwent elective open or laparoscopic colorectal cancer surgery between 2015 and 2019 at a single center was studied. The anesthetic technique used was categorized into either GA or GA + RA using a prospective proforma. The relationship between each anesthetic technique and perioperative clinicopathological characteristics was examined using binary logistic regression analysis.The majority of patients were male (54%), younger than 65 years (41%), either normal or overweight (64%), and were nonsmokers (47%). Also, the majority of patients underwent open surgery (60%) and received mainly general + regional anesthetic technique (80%). On univariate analysis, GA + RA was associated with a lower day 4 CRP (≤150/>150 mg/L) concentration. On day 4, postoperative CRP was associated with anesthetic technique [odds ratio (OR) 0.58; confidence interval (CI) 0.31–1.07; P = .086], age (OR 0.70; CI 0.50–0.98; P = .043), sex (OR 1.15; CI 0.95–2.52; P = .074), smoking (OR 1.57; CI 1.13–2.19; P = .006), preoperative mGPS (OR 1.55; CI 1.15–2.10; P = .004), and preoperative dexamethasone (OR 0.70; CI 0.47–1.03; P = .072). On multivariate analysis, day 4 postoperative CRP was independently associated with anesthetic technique (OR 0.56; CI 0.32–0.97; P = .039), age (OR 0.74; CI 0.55–0.99; P = .045), smoking (OR 1.58; CI 1.18–2.12; P = .002), preoperative mGPS (OR 1.41; CI 1.08–1.84; P = .012), and preoperative dexamethasone (OR 0.68; CI 0.50–0.92; P = .014).There was a modest but an independent association between RA and a lower magnitude of the postoperative SIR. Future work is warranted with multicenter RCT to precisely clarify the relationship between anesthesia and the magnitude of the postoperative SIR.

Mid-axillary transversus abdominis plane block and stress response after abdominal hysterectomy: A randomised controlled placebo trial.

The hormonal response to surgical trauma can have detrimental effects on patients. Transversus abdominis plane (TAP) block, which can improve analgesia after total abdominal hysterectomy (TAH) might attenuate the peri-operative stress response. To evaluate the ability of the TAP block to reduce stress response, opioid consumption and pain following TAH and multimodal analgesia. Randomised, placebo-controlled double-blind study. The current study was conducted at a university hospital from July 2016 to September 2017. Fifty patients scheduled for TAH were included. Anaesthesia and postoperative analgesia were standardised. After induction of anaesthesia, patients were allocated into two groups: ultrasound-guided bilateral mid-axillary TAP block with 20 ml of bupivacaine 0.25% (Group T) or 0.9% saline (Group C). Levels of free serum cortisol, metanephrine and normetanephrine at 60 min and 6, 12 and 24 h after surgical incision. Pain scores and opioid consumption during the first 24 h after surgery. There was no statistically significant difference between the median [IQR] peri-operative levels of stress hormones and pain scores between groups. Compared with baseline value 9.90 [4.2 to 23.1], free serum median cortisol levels were significantly high at 6 h in Group T, 23.6 [10.1 to 42.9] P = 0.015 and Group C 23.6 [9.9 to 46.3] P = 0.014. Only Group C showed significant elevation from the baseline median levels of plasma metanephrine at 60 min, 52.8 [33.4 to 193.2] P = 0.001, 6 h, 92.70 [2.4 to 202.6] P = 0.005 and normetanephrine at 60 min 83.44 [28.98 to 114.86] P = 0.004, 6 h 78.62 [36.6 to 162.31] P = 0.0005 and 24 h 80.96 [8.6 to 110.5] P = 0.025. Mean ± SD opioid consumption was similar in both groups: 39.60 ± 14.87 in Group T vs. 43.68 ± 14.93 in Group C (P = 0.338). Mid-axillary TAP block does not improve stress response and analgesia in patients undergoing TAH receiving multimodal analgesia. ClinicalTrial.gov identifier: NCT03443271.

Dexmedetomidine Versus Clonidine as Adjuvants in Epidural Analgesia in Gynecological Laparotomy

Abstract Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. If the management of acute postoperative pain is not done properly, it can lead to the complication such as chronic pain. Epidural anesthesia reduces perioperative stress response in surgery, increasing the surgery outcome. Epidural analgesia is one of the potential acute postoperative pain treatments. The administration of α-2 agonists has analgesic and sedative effect when used as adjuvant in epidural analgesia. The administration of α-2 adrenergic agonists' adjuvant can increase the potential duration of analgesia and reduce the local anesthetic dose needed 30%–40% and can reduce the occurrence of the side effects. Dexmedetomidine is one of the most potent and high selective alpha-2 adrenergic receptor agonists. The use of dexmedetomidine during epidural anesthesia has faster onset and longer motor sensory blockade duration with hemodynamic stability that can be accepted. While clonidine acts as selective partial alpha-2 receptor agonists that cause the analgesic action of alpha-2 receptor in the dorsal of spinal cord. Clonidine has been shown its ability to reduce the local anesthesia needed and improve the pain scores when is combined with bupivacaine 0.125% with or without fentanyl opioid 1–2 μg/mL.

Ultrasound-guided stellate ganglion block alleviates stress responses and promotes recovery of gastrointestinal function in patients

BackgroundThis study aimed to investigate the effect of preoperative ultrasound-guided stellate ganglion block (SGB) on the perioperative stress responses and gastrointestinal functions of patients undergoing laparoscopic colorectal cancer surgery. MethodsA total of 60 colorectal cancer patients were enrolled in study and were randomized to be treated with or without SGB therapy. In the SGB group, patients were injected with 7 mL 0.5% ropivacaine in stellate ganglion under ultrasound guidance before anesthesia. Mean artery pressure (MAP), heart rate (HR), recovery of bowel sound and first exhaust, as well as levels of motilin, gastrin, norepinephrine, cortisol, interleukin-6 (IL-6) and C-reactive protein (CRP) were recorded at various time points. Results26 patients in the SGB group and 27 patients in the control group were analyzed. No significant differences in MAP or HR were observed between the two groups before, during and after the surgery. SGB promoted recovery of gastrointestinal functions, as evidenced by earlier recovery of bowel sound and first exhaust, as well as increased motilin and gastrin levels. SGB also attenuated stress responses, as shown in reduced norepinephrine, cortisol, IL-6 and CRP levels. ConclusionsSGB promotes the recovery of gastrointestinal functions and reduces stress responses of colorectal patients undergoing laparoscopic colorectal cancer surgery.

Ultrasound-guided internal branch of superior laryngeal nerve block on postoperative sore throat: A randomized controlled trial.

Ultrasound-guided internal branch of the upper laryngeal nerve block (USG-guided iSLN block) have been used to decrease the perioperative stress response of intubation. It is more likely to be successful than blindly administered superior laryngeal nerve blocks with fewer complications. Here, we evaluated the efficacy of USG-guided iSLN block to treat postoperative sore throat (postoperative sore throat, POST) after extubation. 100 patients, aged from 18 to 60 years old, ASA I~II who underwent general anesthesia and suffered from the moderate to severe postoperative sore throat after extubation were randomized into two groups(50 cases per group). Patients in group S received USG-guided iSLN block bilaterally (60mg of 2% lidocaine, 1.5ml each side), whereas those in group I received inhalation with 100 mg of 2% lidocaine and 1mg of budesonide suspension diluted with normal saline (oxygen flow 8 L /min, inhalation for 15 minutes). The primary outcome were VAS scores in both groups before treatment (T0), 10 min (T1), 30 min(T2), 1h(T3), 2 h(T4), 4h(T5), 8h(T6), 24h(T7), and 48h(T8) after treatment. The secondary outcome were satisfaction scores after treatment, MAP, HR, and SPO2 fromT0 to T8. The adverse reactions such as postoperative chocking or aspiration, cough, hoarseness, dyspnea were also observed in both groups. Patients in group S had significantly lower VAS score than that in group I at points of T1 ~ T6 (P < 0.01). HR of group S was lower than that of group I at points of T1 ~ T2and T4 (P < 0.05), and MAP was lower than that of group I at points of T1 ~ T3 (P < 0.05). Satisfaction scores of group S were higher than that of group I (P <0.05), In group S, 2 case (4%) needed to intravenous Flurbiprofen Injection 50 mg to relieve pain; in group I, 13 cases (26%) received Flurbiprofen Injection. 2 case of group S appeared throat numbness after treatment for 3 hours; 2 patients have difficult in expectoration after treatment recovered after 3hour. No serious adverse events were observed in both groups. Compared with inhalation, USG-guided iSLN block may effectively relieve the postoperative sore throat after extubation under general anesthesia and provided an ideal treatment for POST in clinical work.

The role of rating scales in the diagnosis of postoperative insomnia

Background. Sleep disorders can be considered as an integral expression of the perioperative stress response. Postoperative insomnia is one of the most common postoperative complications: the incidence is exceed 70 %. The gold standard for the diagnosis of insomnia is polysomnography, which is rarely available in postoperative patients. Instead, rating scales are an easy-to-use, inexpensive and affordable tool.&#x0D; Objective. To compare scales for assessment of sleep in postoperative patients.&#x0D; Materials and methods. The study included 38 patients after general surgery. The age was 26-68 years (54.6±9.4). The gender distribution: 16 men and 22 women. All patients undergo an overnight 10-hour video-EEG. EEG patterns of insomnia were considered sleep latency of more than 30 min, wakefulness during sleep more than 30 min, total sleep time less than 6.5 h, sleep efficiency index &lt;84 %. The Athens Insomnia Scale (AIS), Richards – Campbell Sleep Questionnaire (RCSQ) and Insomnia Severity Index (ISI) was applied to patients the day after surgery. For reliability analysis was used Cronbach’s alpha. Were calculated sensitivity and specificity of the scales.&#x0D; Results. Video-EEG patterns of insomnia was present in 15 subjects. The rest 23 subjects did not have signs of insomnia in video-EEG. The Cronbach’s alpha for AIS was 0.90, for RCSQ – 0.89 and for ISI – 0.86. The sensitivity of AIS for postoperative insomnia was 84.6 %, RCSQ – 76.9 % and ISI – 69.2 %. The specificity level was 85.7 % for AIS, 81.0 % for RCSQ, and 69.2 % for ISI.&#x0D; Conclusions. The rating scales used in the study showed sufficient reliability, sensitivity and specificity and can be used as a valid method of assessing sleep in postoperative patients.

Alterations in blood microbiota after colonic cancer surgery.

BackgroundMechanisms contributing to the perioperative stress response remain poorly understood. This study investigated changes in the amount of bacterial DNA in blood and the diversity of blood microbiota in the perioperative period in patients undergoing minimally invasive surgery for colonic cancer in an enhanced recovery after surgery setting.MethodsDNA encoding the bacterial 16S ribosomal RNA gene (16S rDNA) in whole blood obtained the day before surgery, and on postoperative day (POD) 1 and POD 10–14 was amplified and quantified by PCR before sequencing for taxonomic assignment. Richness, evenness and similarity measures were calculated to compare microbiota between days. Differences in relative abundance were analysed using the linear discriminant analysis effect size (LEfSe) algorithm.ResultsThirty patients were included between January and July 2016. The concentration of bacterial 16S rDNA in blood increased between the day before surgery and POD 1 (P = 0.025). Bacterial richness was lower on POD 10–14 than on the day before surgery and POD 1 (both P < 0·001). LEfSe analysis comparing the day before surgery and POD 10–14 identified changes in the abundance of several bacteria, including Fusobacterium nucleatum, which was relatively enriched on POD 10–14.ConclusionThese findings suggest that the blood of patients with colonic cancer harbours bacterial 16S rDNA, which increases in concentration after surgery.

The value of acupuncture-moxibustion in enhance recovery after surgery

Enhance recovery after surgery (ERAS) is an emerging discipline aiming to reduce perioperative stress response and postoperative complications and promote better and faster recovery of patients. In this study, the potential value and feasibility of acupuncture in ERAS is discussed from three aspects: acupuncture can reduce the demand of perioperative analgesic drugs, improve the postoperative gastrointestinal function, and prevent and treat postoperative complications. The combination of acupuncture and ERAS can better promote the rehabilitation of patients, complement the advantages of acupuncture and ERAS, and promote the development of acupuncture and ERAS.

Minimizing the impact of colorectal surgery in the older patient: The role of enhanced recovery programs in older patients

Enhanced recovery after surgery (ERAS) programs are multimodal treatment bundles designed with the aim to decrease the perioperative stress response to surgical trauma and reduce complication rates with elective surgery. They include different items in the preoperative, intra-operative, and postoperative phases that are based on prospective randomized trials with different grades of evidence. Their use is widespread in colorectal surgery and they have been proven to improve outcomes.Older patients are a specific group of patients with particular needs, due to age-related decline in physiological reserve and functional capacity, and frequent co-morbidity. There has been some hesitation to apply ERAS pathways in the older population, because of a lower compliance with the ERAS measures and a higher postoperative morbidity in these patients. However, recent studies have shown that most elements of the ERAS programs can be applied safely in older patients with the same benefits in reducing general complications and perioperative mortality as in younger patients.

Effect of Dexmedetomidine on Perioperative Stress Response and Immune Function in Patients With Tumors

Objective:This study aims to investigate the effect of dexmedetomidine on perioperative stress response and immune function in patients with tumors.Methods:Sixty patients who underwent selective radical gastrectomy for cancer were randomly divided into 3 groups: remifentanil group (group R), dexmedetomidine group (group D), and sufentanil group (group S). Remifentanil, dexmedetomidine, and sufentanil were used as general anesthetics. Endotracheal intubation and mechanical ventilation were performed after the spontaneous respiration disappeared. Then, the data were recorded, and blood samples were collected at all time points.Results:The heart rate significantly increased (P < 0.05) at T1 in group S, and both heart rate and mean arterial pressure significantly increased (P < 0.05) in group R when compared to group D. The heart rate significantly increased (P < 0.05) at T2 in group S and group R. Furthermore, the heart rate significantly increased (P < 0.05) at T3 and T4 in group S and group R. Intra-group comparison: The heart rate at T1–T4 and mean arterial pressure at T1–T4 significantly increased (P < 0.05) in group S, and the heart rate at T1 and T4, and mean arterial pressure at T2–T4 significantly increased (P < 0.05) in group R when compared to T0. The serum IL-6, IFN-γ, and β-EP significantly increased (P < 0.05) at T0’ in group S and group R when compared to group D. Blood glucose, and serum IL-10, IFN-γ, and β-EP significantly increased (P < 0.05), while IL-18 significantly decreased (P < 0.05) at T1’ in group S and group R.Conclusion:Continuous infusion of dexmedetomidine in combination with the inhalation of sevoflurane is superior to sevoflurane + remifentanil or sufentanil in patients undergoing tumor surgery.

Transversus abdominis plane block with general anesthesia blunts the perioperative stress response in patients undergoing radical gastrectomy

BackgroundSurgical stress induces the release of neuroendocrine mediators and cytokines during perioperative period, which may have adverse effects on cancer patients. While the surgical stress responsse can be affected by anesthetic technique. Therefore, we designed this study to assess whether subcostal transversus abdominis plane (TAP) block can affect perioperative neuroendocrine stress response, postoperative analgesia and postoperative recovery in patients undergoing radical gastrectomy under general anesthesia.MethodsSixty-five patients were recruited. Patients randomly received general anesthesia (control group), or general anesthesia combined with TAP block (40 mL of 0.375% ropivacaine) (TAP group). The primary outcome was neuroendocrine levels including norepinephrine (NE), epinephrine (E), cortisol (Cor), glucose (Glu), interleukin (IL)-6 and IL-10 during 48 h after surgery. Secondary outcomes included pain score, hemodynamic variables and recovery characteristics.ResultsData from 61 of 65 patients were analyzed. The levels of NE, E, Cor, and Glu were blunt by TAP block during perioperative period. The levels of IL-6 and IL-10 were significantly lower in TAP group than in control group. TAP block efficiently relieved postoperative acute pain up to 12 h postoperatively with more stable perioperative hemodynamics compared with control group.ConclusionsSubcostal TAP block blunts perioperative stress response and provides efficient analgesia, with good hemodynamic stability and minimal adverse effects.