Combination of Epidural Anesthesia and General Anesthesia Attenuates Stress Response to Renal Transplantation Surgery

Hadimioğlu, Necmiye; Ulugöl, Halim; Akbaş, Halide; Coşkunfırat, Nesil; Ertuğ, Zeki; Dınçkan, Ayhan

doi:10.1016/j.transproceed.2012.08.004

“…Our low detection rate is similar to findings in other studies in healthy patients ventilated during surgery 2 and reinforces the normal pulmonary status of our study patients. Plasma cytokine concentrations did not significantly change in relation to surgical trauma or greater V T. Possible contributing factors to this finding were the short study duration, lack of lung injury, or preoperative regional anesthesia 67,68 . However, the inhibitory effect of regional anesthesia on systemic inflammatory response after orthopedic surgery is still unproven 69,70 .…”

Section: Discussionmentioning

confidence: 71%

Early Effect of Tidal Volume on Lung Injury Biomarkers in Surgical Patients with Healthy Lungs

Fernandez-Bustamante

¹

,

Klawitter

²

,

Repine

³

et al. 2014

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Background The early biological impact of short-term mechanical ventilation on healthy lungs is unknown. We aimed to characterize the immediate tidal volume (VT)-related changes on lung injury biomarkers in patients with healthy lungs and low risk of pulmonary complications. Methods Twenty-eight healthy patients for knee replacement surgery were prospectively randomized to volume-controlled ventilation with VT 6 (VT6) or 10 (VT10) mL/kg predicted body weight. General anesthesia and other ventilatory parameters (positive end-expiratory pressure 5 cmH2O, FiO2 0.5, respiratory rate titrated for normocapnia) were managed similarly in the two groups. Exhaled breath condensate (EBC) and blood samples were collected for nitrite, nitrate, tumor necrosis factor α, interleukins-1β, 6, 8, 10, 11, neutrophil elastase (NE), and Clara Cell protein 16 (CC16) measurements, at the onset of ventilation and 60 min later. Results No significant differences in biomarkers were detected between the VT groups at any time. The coefficient of variation of EBC nitrite and nitrate decreased in the VT6 but increased in the VT10 group after 60-min ventilation. Sixty minute ventilation significantly increased plasma NE levels in the VT6 (35.2 ± 30.4 vs. 56.4 ± 51.7 ng/mL, P = 0.008) and CC16 levels in the VT10 group (16.4 ± 8.8 vs. 18.7 ± 9.5 ng/mL, P = 0.015). EBC nitrite correlated with plateau pressure (r = 0.27, P = 0.042) and plasma NE (r = 0.44, P = 0.001). Plasma CC16 correlated with compliance (r = 0.34, P = 0.014). Conclusion No tidal volume-related changes were observed in the selected lung injury biomarkers of patients with healthy lungs after 60-min ventilation. Plasma NE and plasma CC16 might indicate atelectrauma and lung distention, respectively.

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“…Our low detection rate is similar to findings in other studies in healthy patients ventilated during surgery 2 and reinforces the normal pulmonary status of our study patients. Plasma cytokine concentrations did not significantly change in relation to surgical trauma or greater V T. Possible contributing factors to this finding were the short study duration, lack of lung injury, or preoperative regional anesthesia 67,68 . However, the inhibitory effect of regional anesthesia on systemic inflammatory response after orthopedic surgery is still unproven 69,70 .…”

Section: Discussionmentioning

confidence: 71%

Early Effect of Tidal Volume on Lung Injury Biomarkers in Surgical Patients With Healthy Lungs

Fernandez-Bustamante

¹

,

Klawitter

²

,

Repine

³

et al. 2015

Survey of Anesthesiology

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“…1,23 Many clinical studies have shown that proinflammatory and antiinflammatory cytokines are pivotal for the acute-phase inflammatory and immunologic response after surgical trauma, and the most important cytokines in this regard are TNF-α, IL-6, and IL-10. [24][25][26] The release of TNF-α is 1 of the main cytokines that mediate the early response to tissue injury. IL-6 is the primary stimulus for acute responses, and plasma levels of IL-6 are reportedly related to the severity of surgical trauma.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine Combined with General Anesthesia Provides Similar Intraoperative Stress Response Reduction When Compared with a Combined General and Epidural Anesthetic Technique

Li

¹

,

Wang

²

,

Zhang

³

et al. 2016

Anesthesia &Amp; Analgesia

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Combination of Epidural Anesthesia and General Anesthesia Attenuates Stress Response to Renal Transplantation Surgery

Cited by 46 publications

References 27 publications

Early Effect of Tidal Volume on Lung Injury Biomarkers in Surgical Patients with Healthy Lungs

Early Effect of Tidal Volume on Lung Injury Biomarkers in Surgical Patients with Healthy Lungs

Early Effect of Tidal Volume on Lung Injury Biomarkers in Surgical Patients With Healthy Lungs

Dexmedetomidine Combined with General Anesthesia Provides Similar Intraoperative Stress Response Reduction When Compared with a Combined General and Epidural Anesthetic Technique

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