Analysis of the postoperative hemostatic profile of colorectal cancer patients subjected to liver metastasis resection surgery  

作　　者：Guillermo Perez Navarro Ana Maria Pascual Bellosta Sonia María Ortega Lucea Mario Serradilla Martín Jose Manuel Ramirez Rodriguez Javier Martinez Ubieto 

机构地区：[1]Department of Anesthesiology,University Hospital Miguel Servet,Zaragoza 50009,Spain [2]Department of General Surgery,University Hospital Miguel Servet,Zaragoza 50009,Spain [3]Department of General Surgery,University Hospital Lozano Blesa,Zaragoza 50009,Spain

出　　处：《World Journal of Clinical Cases》2019年第17期2477-2486,共10页世界临床病例杂志

摘　　要：BACKGROUND Liver resection surgery has advanced greatly in recent years,and the adoption of fasttrack programs has yielded good results.Combination anesthesia (general anesthesia associated to epidural analgesia) is an anesthetic-analgesic strategy commonly used for the perioperative management of patients undergoing surgery of this kind,though there is controversy regarding the coagulation alterations it may cause and which can favor the development of spinal hematomas.AIM To study the postoperative course of liver resection surgery,an analysis was made of the outcomes of liver resection surgery due to colorectal cancer metastases in our centre in terms of morbiditymortality and hospital stay according to the anesthetic technique used (general vs combination anesthesia).METHODS A prospective study was made of 61 colorectal cancer patients undergoing surgery due to liver metastases under general and combination anesthesia between January 2014 and October 2015.The patient characteristics,intraoperative variables,postoperative complications,evolution of hemostatic parameters,and stay in intensive care and in hospital were analyzed.RESULTS A total of 61 patients were included in two homogeneous groups: general anesthesia (n = 30) and combination anesthesia (general anesthesia associated to epidural analgesia)(n = 31).All patients had normal coagulation values before surgery.The international normalized ratio (INR) in both the general and combination anesthesia groups reached maximum values at 2448 h (mean 1.37 and 1.45 vs 1.39 and 1.41,respectively),followed by a gradual decrease.There was less intraoperative bleeding in the combination anesthesia group (769 mL) than in the general anesthesia group (1200 mL)(P < 0.05).Of the 61 patients,38.8% in the general anesthesia group experienced some respiratory complication vs 6.6% in the combination anesthesia group (P < 0.001).The time to gastrointestinal tolerance was significantly correlated to the type of anesthesia,though not so the stay in critical care or the time toBACKGROUND Liver resection surgery has advanced greatly in recent years, and the adoption of fasttrack programs has yielded good results. Combination anesthesia(general anesthesia associated to epidural analgesia) is an anesthetic-analgesic strategy commonly used for the perioperative management of patients undergoing surgery of this kind, though there is controversy regarding the coagulation alterations it may cause and which can favor the development of spinal hematomas.AIM To study the postoperative course of liver resection surgery, an analysis was made of the outcomes of liver resection surgery due to colorectal cancer metastases in our centre in terms of morbiditymortality and hospital stay according to the anesthetic technique used(general vs combination anesthesia).METHODS A prospective study was made of 61 colorectal cancer patients undergoing surgery due to liver metastases under general and combination anesthesia between January 2014 and October 2015. The patient characteristics,intraoperative variables, postoperative complications, evolution of hemostatic parameters, and stay in intensive care and in hospital were analyzed.RESULTS A total of 61 patients were included in two homogeneous groups: general anesthesia(n = 30) and combination anesthesia(general anesthesia associated to epidural analgesia)(n = 31). All patients had normal coagulation values before surgery. The international normalized ratio(INR) in both the general and combination anesthesia groups reached maximum values at 2448 h(mean 1.37 and 1.45 vs 1.39 and 1.41, respectively), followed by a gradual decrease. There was less intraoperative bleeding in the combination anesthesia group(769 m L)than in the general anesthesia group(1200 m L)(P < 0.05). Of the 61 patients,38.8% in the general anesthesia group experienced some respiratory complication vs 6.6% in the combination anesthesia group(P < 0.001). The time to gastrointestinal tolerance was significantly correlated to the type of anesthesia,though not so the stay in critical care or the

关 键 词：HEPATECTOMY EPIDURAL ANALGESIA PERIOPERATIVE complications EPIDURAL HEMATOMA Multimodal rehabilitation Outcomes 

分 类 号：R[医药卫生]