The effect of combined spinal-epidural anesthesia versus general anesthesia on the recovery time of intestinal function in young infants undergoing intestinal surgery: a randomized, prospective, controlled trial

Somri, Mostafa; Matter, Ibrahim; Parisinos, Constantinos; Shaoul, Ron; Bader, David A.; Asphandiarov, Eldar; Gaitini, Luis

doi:10.1016/j.jclinane.2012.02.004

Cited by 21 publications

(22 citation statements)

References 32 publications

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“…It has been shown that small intestine functions begin to resume between 6 and 12 h after surgery (Somri et al, 2012), indicating that EN support could be started at that time. When the intestine works, enteral nutrition support can be given (Rottiers et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

Impact of enteral nutrition on postoperative immune function and nutritional status

Wang¹,

Hou²,

Wu³

et al. 2015

Genet. Mol. Res.

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ABSTRACT. We studied the effects of enteral nutrition (EN) support initiated 1 week before surgery on postoperative nutritional status, immune function, and inflammatory response in gastric cancer patients. A total of 200 gastric cancer patients were randomly divided into two groups: EN starting 1 week before surgery (study group) and EN starting early after surgery (control group). The two groups received EN support, following different therapeutic schedules, until the 9th day after operation. In the patients, body weight, skinfold thickness, upper-arm circumference, white blood cell count, albumin, prealbumin, C-reactive protein, peripheral immunoglobulins (IgA, IgG, and IgM), T lymphocyte subsets, interleukin-6, and tumor necrosis factor-α were measured 10 days before and after surgery and on the first day after surgery. There was no statistically significant difference in the results of recovery time of passage of gas by anus, abdominal distension, stomachache, blood glucose, hepatic and renal functions, and electrolytes between the two groups of patients (P > 0. 05). Adverse reactions occurred to both groups at 1 and 2 days after operation. Such conditions was improved after the intravenous drip rate was adjusted. The albumin and prealbumin levels of the patients in both groups decreased at 1 day after operation (P < 0. 05). The levels rose when the research was finished (P < 0. 05). The prealbumin level of the study group was higher than that of the control group at 10 days after operation (P < 0. 05). The IgG level of the study group was higher than that of the control group at 10 days after operation (P < 0. 05). The two groups of inflammatory reaction indicators of the study group were lower than those of the control group at 10 days after operation (P < 0. 05). This study indicates that appropriate preoperative EN support for gastric cancer patients can improve their postoperative nutritional status and immune function, can reduce inflammatory response, and is more conducive to the recovery of patients.

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Section: Discussionmentioning

confidence: 99%

Impact of enteral nutrition on postoperative immune function and nutritional status

Wang¹,

Hou²,

Wu³

et al. 2015

Genet. Mol. Res.

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“…A sample size of 21 patients in each group with a risk of 0.05 was required for the study. After adding nine subjects to each group to compensate for an expected attrition rate of 10%, the sample size was estimated at 30 patients for each study arm …”

Section: Methodsmentioning

confidence: 99%

“…The length and severity of POI can be influenced by the anaesthetic technique . In previous work, we reported the positive effects of combined spinal‐epidural anaesthesia (CSEA) vs general anaesthesia (GA) alone on gastrointestinal function recovery in neonates …”

Section: Introductionmentioning

confidence: 99%

Combined epidural‐general anaesthesia vs general anaesthesia in neonatal gastrointestinal surgery: A randomized controlled trial

Gannam-Somri

Matter

Hadjittofi

et al. 2019

Acta Anaesthesiol Scand

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Post-operative ileus (POI) is a frequent and multifactorial complication of gastrointestinal surgery. POI results in abdominal distension, delayed oral nutrition, and increased morbidity. 1 Prolonged post-operative fasting leads to thinning of the intestinal mucosa with decreased enzymatic activity, whereas early post-operative feeding can benefit the immune system and intestinal recovery, thereby minimizing morbidity and mortality. [2][3][4] The length and severity of POI can be influenced by the anaesthetic technique. 5-7 In previous work, 8 we reported the positive effects of combined spinal-epidural anaesthesia (CSEA) vs general anaesthesia (GA) alone on gastrointestinal function recovery in neonates. 8 We hypothesized that combined epidural-general anaesthesia (CEGA) may enhance the post-operative recovery of gastrointestinal function vs GA alone. The aim of this study was to investigate whether the time to gastrointestinal function recovery is different in neonates who undergo elective gastrointestinal surgery under Background: Post-operative ileus is a frequent complication of gastrointestinal surgery under general anaesthesia. The aim of this study was to investigate whether combined epidural-general anaesthesia is associated with expedited gastrointestinal function recovery in neonates undergoing elective gastrointestinal surgery. Methods: A randomized controlled trial including 60 neonates who underwent gastrointestinal surgery at a university hospital was performed. Thirty neonates received combined epidural-general anaesthesia (CEGA), and 30 neonates received general anaesthesia (GA) alone. The primary outcome was the post-operative time to tolerance of full enteral nutrition. The secondary outcomes were the post-operative time defaecation, the duration of nasogastric drainage, and infections. Results: After excluding two neonates from the CEGA group, where repeated attempts at epidural catheterization were unsuccessful, a total of 58 patients completed the study (CEGA: 28; GA: 30). Full enteral nutrition was tolerated earlier in CEGA vs the GA group (4.0 vs 8.0 days; P = .0001). Time to defaecation was shorter in the CEGA group (3.5 vs 5.0 days; P = .0001). Duration of nasogastric drainage was similar between groups (7.0 vs 7.0 days; P = .9502). Fewer patients in the CEGA group experienced post-operative infection (35.7% vs 60.0%; P = .038). Conclusion: Combined epidural-general anaesthesia is associated with expedited gastrointestinal function recovery and a lower infection risk after gastrointestinal surgery in neonates.

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“…CSEA also significantly decreases the incidence of postoperative cardiorespiratory adverse events in the neonatal intensive care unit, when compared with general anaesthesia in high-risk infants undergoing similar gastrointestinal procedures [72]. A recent randomised controlled study demonstrated that CSEA enables early recovery of intestinal function, reduces intra-and postoperative use of opioid analgesia and results in less frequent postoperative abdominal distension and pneumonia in infants compared to general anaesthesia [73].…”

Section: Anaesthetic Techniquementioning

confidence: 99%

Improved outcomes in paediatric anaesthesia: contributing factors

Somri

Coran

Hadjittofi³

et al. 2012

Pediatr Surg Int

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Despite substantial progress, there is still much room for improvement in areas such as adverse-event reporting, anaesthetic-related risk and late neurocognitive outcomes. Systematic reviews comparing paediatric patient outcomes after neuroaxial block versus general anaesthesia are currently unavailable. The future of paediatric anaesthesia will most likely be influenced by much-needed large prospective studies, which can provide further insight into patient safety and service delivery.

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The effect of combined spinal-epidural anesthesia versus general anesthesia on the recovery time of intestinal function in young infants undergoing intestinal surgery: a randomized, prospective, controlled trial

Cited by 21 publications

References 32 publications

Impact of enteral nutrition on postoperative immune function and nutritional status

Impact of enteral nutrition on postoperative immune function and nutritional status

Combined epidural‐general anaesthesia vs general anaesthesia in neonatal gastrointestinal surgery: A randomized controlled trial

Improved outcomes in paediatric anaesthesia: contributing factors

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