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2.
Microcirculation ; : e12608, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31991513

RESUMO

OBJECTIVE: We aimed to determine whether high-dose nitroglycerin, a nitric oxide donor, preserves erythrocyte deformability during cardiopulmonary bypass and examines the signaling pathway of nitric oxide in erythrocytes. METHODS: In a randomized and controlled fashion, forty-two patients undergoing cardiac surgery with hypothermic cardiopulmonary bypass were allocated to high-dose (N = 21) and low-dose groups (N = 21). During rewarming period, patients were given intravenous nitroglycerin with an infusion rate 5 and 1 µg·kg-1 ·min-1 in high-dose and low-dose groups, respectively. Tyrosine phosphorylation level of non-muscle myosin IIA in erythrocyte membrane was used as an index of erythrocyte deformability and analyzed using immunoblotting. RESULTS: Tyrosine phosphorylation of non-muscle myosin IIA was significantly enhanced after bypass in high-dose group (3.729 ± 1.700 folds, P = .011) but not low-dose group (1.545 ± 0.595 folds, P = .076). Phosphorylation of aquaporin 1, vasodilator-stimulated phosphoprotein, and focal adhesion kinase in erythrocyte membrane was also upregulated in high-dose group after bypass. Besides, plasma nitric oxide level was highly correlated with fold change of non-muscle myosin IIA phosphorylation (Pearson's correlation coefficient .871). CONCLUSIONS: High-dose nitroglycerin administered during cardiopulmonary bypass improves erythrocyte deformability through activating phosphorylation of aquaporin 1, vasodilator-stimulated phosphoprotein, and focal adhesion kinase in erythrocytes.

4.
J Chin Med Assoc ; 83(1): 89-94, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31904743

RESUMO

BACKGROUND: Although epidural analgesia (EA) provides reliable pain relief after major operations, few studies have explored how postoperative pain trajectories change over time in patients receiving EA and the associated factors. This study aimed to model the dynamic features of pain trajectories after surgery and investigate factors associated with their variations using latent curve analysis. METHODS: This retrospective study was conducted at a single medical center in Taiwan, and data were obtained from patients receiving perioperative EA by electronic chart review. Mean numeric rating pain scores were recorded daily in the first five postoperative days. Patient demographics, surgical sites, and infusion pump settings were also collected. Latent curve models using two latent variables, intercept and slope, were developed to explain the variations in postoperative pain scores over time. The influences of potential predictors of postoperative pain trajectories were further evaluated for the final model determination. RESULTS: Of the 1294 collected patients, the daily pain scores averaged 2.0 to 2.9 for different surgical sites. Among the nine significant factors influencing pain trajectories, chest and lower extremity surgery tended to induce less and more baseline pain, respectively, than those with abdomen surgery (both p < 0.001). In addition, male patients and those with a shorter anesthesia time had less baseline pain (p < 0.001 and p = 0.016, respectively). The older and lighter patients and those with chest surgery or American Society of Anesthesiologists class ≥ 3 tended to have milder decreasing trends in pain trajectories. A higher infusion rate was associated with an elevated baseline level and smoother decreasing trend in pain trajectory. The final model fit our data acceptably (root mean square error of approximation = 0.05, comparative fit index = 0.97). CONCLUSION: Latent curve analysis provided insights into the dynamic nature of variations in postoperative pain trajectories. Further studies investigating more factors associated with pain trajectories are warranted to elucidate the mechanisms behind the transitions of pain scores over time after surgery.

5.
J Chin Med Assoc ; 83(2): 194-201, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31868859

RESUMO

BACKGROUND: Chronic pain is a common postoperative complication in patients undergoing major surgery and may significantly affect their quality of life (QOL). Whether patient-controlled analgesia (PCA) can reduce the risk of chronic postsurgical pain and promote long-term QOL is still unclear. METHODS: In this prospective cohort study, we followed up patients undergoing major surgery, recorded changes in their postoperative QOL over time using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire and chronic pain events, evaluated the long-term effects of distinct PCA techniques (intravenous, epidural, or none) on their QOL and risk of chronic pain, and explored relevant predictors. The patients' QOL and chronic pain events were collected preoperatively, 3, 6, and 12 months after surgery. Generalized linear mixed models were used to control for individual heterogeneity and adjust for potential confounding factors. RESULTS: We included 328 patients undergoing major surgery from September 22, 2015, to December 31, 2016, in this study. Multivariate regression models showed that patients using intravenous PCA had a better QOL in physical health (adjusted coefficient 3.7, 95% CI, 0.5-8.0) compared with those receiving non-PCA treatments. Distinct PCA techniques did not significantly affect QOL in psychological, social relationship, or environmental domains of the WHOQOL-BREF scale or the risk of chronic postsurgical pain. CONCLUSION: Patients using intravenous PCA had a better QOL in physical health over time after major surgery, which may have been due to factors other than pain-relieving effects.

6.
BMJ Open ; 9(11): e031936, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699739

RESUMO

OBJECTIVES: We aimed to investigate the factors associated with variations in postoperative pain trajectories over time in patients using intravenous patient-controlled analgesia (IV-PCA) for postoperative pain. DESIGN: Retrospective cohort study. SETTING: A single medical centre in Taiwan. PARTICIPANTS: Patients receiving IV-PCA after surgery. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was the postoperative pain scores. RESULTS: A total of 3376 patients and 20 838 pain score observations were analysed using latent curve models. Female and longer anaesthesia time increased the baseline level of pain (p=0.004 and 0.003, respectively), but abdominal surgery and body weight decreased it (both p<0.001). Regarding the trend of pain resolution, lower abdominal surgery steepened the slope (p<0.001); older age, American Society of Anesthesiologists (ASA) class ≥3 and longer anaesthesia time tended to flatten the slope (p<0.001, =0.019 and <0.001, respectively). PCA settings did not affect the variations in postoperative pain trajectories. CONCLUSIONS: Patient demographics, ASA class, anaesthesia time and surgical sites worked together to affect postoperative pain trajectories in patients receiving IV-PCA. Latent curve models provided valuable information about the dynamic and complex relationships between the pain trajectories and their influential factors.

7.
J Chin Med Assoc ; 82(11): 865-871, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31373923

RESUMO

BACKGROUND: Although animal studies have shown that pain can suppress host immunity and promote tumor metastasis, few clinical studies have evaluated the association between acute pain and long-term outcomes after cancer surgery. METHODS: Patients undergoing colorectal cancer resection at a medical center between November 2010 and December 2014 were collected. Pain intensity was recorded using a numeric rating scale at 12, 24, 36, 48, 72, 96, and 120 hours postoperatively. Group-based modeling of longitudinal pain scores was used to categorize pain trajectories. Recurrence-free survival and overall survival were analyzed using Cox proportional hazards models. RESULTS: A total of 2401 patients with 13 931 pain score observations were analyzed. The trajectory model identified three groupings of inpatient postsurgical pain, including 70.3% with mild pain dropping to low (group 1), 20.0% with moderate/severe pain dropping to mild (group 2), and 9.7% with moderate pain rebounding to severe (group 3). Univariate models showed that pain trajectories were significantly associated with recurrence-free survival (group 2 vs 1: hazard ratio [HR], 1.23; 95% CI, 1.02-1.47 and group 3 vs 1: HR, 1.63; 95% CI, 1.30-2.04) and overall survival (group 2 vs 1: HR, 1.36; 95% CI, 1.05-1.77 and group 3 vs 1: HR, 1.81; 95% CI, 1.31-2.51). However, the associations disappeared after adjusting for other significant risk factors. CONCLUSION: Abnormal pain resolution identified by pain trajectory analysis and resulting from complex interactions among disease progression, surgery, and analgesia may be considered as an indicator of an inferior prognosis following colorectal cancer resection.

8.
J Chin Med Assoc ; 82(10): 787-790, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31356570

RESUMO

BACKGROUND: Whether perioperative blood transfusions are associated with long-term outcomes remains controversial. This study aimed to evaluate the effect of blood transfusions on overall survival in hip fracture patients. METHODS: This retrospective survey was conducted at a single medical center and enrolled patients aged ≥ 70 years who received hip fracture surgery between 2013 and 2015. Multivariate Cox regression analysis was used to estimate the effect of blood transfusions on overall survival after surgery. Furthermore, patients who received a blood transfusion were further matched to those who did not receive a blood transfusion by patient characteristics. Stratified Cox regression analysis was used to assess the effect of transfusions on overall survival after matching. RESULTS: A total of 718 patients with a median follow-up period of 25.9 months were included in the analysis, of whom 495 (68.9%) received a blood transfusion. Four independent risk factors for mortality were identified, including male sex (hazard ratio [HR], 1.48; 95% CI, 1.01-2.17), aging (HR, 1.03; 95% CI, 1.0-1.06), general anesthesia (HR, 1.61; 95% CI, 1.11-2.31), and anemia status (mild vs no anemia: HR, 1.67; 95% CI, 0.96-2.90 and moderate versus no anemia: HR, 4.14; 95% CI, 2.35-7.3). The effect of blood transfusions on overall survival was nonsignificant after adjusting for the selected risk factors (HR, 1.44; 95% CI, 0.87-2.36). After matching, the effect of blood transfusions on overall survival remained nonsignificant (HR, 1.7; 95% CI, 0.78-3.71). CONCLUSION: No association was found between blood transfusions and overall survival among elderly patients undergoing hip fracture surgery. More prospective studies are necessary to elucidate the association between blood transfusions and long-term outcomes in patients receiving hip fracture surgery.

9.
BMJ Open ; 9(5): e027618, 2019 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-31152035

RESUMO

OBJECTIVES: Previous studies showed reductions in recurrence and mortality rate of several cancer types in patients receiving perioperative epidural analgesia. This study aimed to investigate the effects of thoracic epidural analgesia on oncological outcomes after resection for lung cancer. DESIGN: Retrospective study using propensity score matching methodology. SETTING: Single medical centre in Taiwan. PARTICIPANTS: Patients with stages I-III non-small-cell lung cancer undergoing primary tumour resection between January 2005 and December 2015 and had either epidural analgesia, placed preoperatively and used intra- and postoperatively, or intravenous analgesia were evaluated through May 2017. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary endpoint was postoperative recurrence-free survival and secondary endpoint was overall survival. RESULTS: The 3-year recurrence-free and overall survival rates were 69.8% (95% CI 67.4% to 72.2%) and 92.4% (95% CI 91% to 93.8%) in the epidural group and 67.4% (95% CI 62.3% to 72.5%) and 89.6% (95% CI 86.3% to 92.9%) in the non-epidural group, respectively. Multivariable Cox regression analysis before matching demonstrated no significant difference in recurrence or mortality between groups (adjusted HR: 0.93, 95% CI 0.76 to 1.14 for recurrence; 0.81, 95% CI 0.58 to 1.13 for mortality), similar to the results after matching (HR: 0.97, 95% CI 0.71 to 1.31; 0.94, 95% CI 0.57 to 1.54). Independent risk factors for both recurrence and mortality were male, higher pretreatment carcinoembryonic antigen level, advanced cancer stage, poor differentiation, lymphovascular invasion, microscopic necrosis and postoperative radiotherapy. CONCLUSIONS: Thoracic epidural analgesia was not associated with better recurrence-free or overall survival in patients receiving surgical resection for stages I-III non-small-cell lung cancer.

10.
Medicine (Baltimore) ; 98(18): e15442, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045812

RESUMO

Whether morphine used in human cancer surgery would exert tumor-promoting effects is unclear. This study aimed to investigate the effects of morphine dose on cancer prognosis after colorectal cancer (CRC) resection.In a retrospective study, 1248 patients with stage I through IV CRC undergoing primary tumor resections and using intravenous patient-controlled analgesia for acute surgical pain at a tertiary center between October 2005 and December 2014 were evaluated through August 2016. Progression-free survival (PFS) and overall survival (OS) were analyzed using proportional hazards regression models.Multivariable analysis demonstrated no dose-dependent association between the amount of morphine dose and PFS (adjusted hazard ratio, HR = 1.31, 95% confidence interval, CI = 0.85-2.03) or OS (adjusted HR = 0.86, 95% CI = 0.47-1.55). Patients were further classified into the high-dose and low-dose groups by the median of morphine consumption (49.7 mg), and the morphine doses were mean 75.5 ± standard deviation 28.8 mg and 30.1 ±â€Š12.4 mg in high-dose and low-dose groups, respectively. Multivariable models showed no significant difference in PFS or OS between groups, either (adjusted HR = 1.24, 95% CI = 0.97-1.58 for PFS; adjusted HR = 1.01, 95% CI = 0.71-1.43 for OS).Our results did not support a definite association between postoperative morphine consumption and cancer progression or all-cause mortality in patients following CRC resection.


Assuntos
Analgésicos Opioides/administração & dosagem , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/cirurgia , Morfina/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/uso terapêutico , Progressão da Doença , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morfina/uso terapêutico , Estadiamento de Neoplasias , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Análise de Sobrevida , Centros de Atenção Terciária
11.
J Chin Med Assoc ; 82(2): 120-125, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30839502

RESUMO

BACKGROUND: The aim of the study was to evaluate the effects of high-dose nitroglycerine administered during cardiopulmonary bypass on the intraoperative cerebral saturation and postoperative serum creatinine concentration in cardiac surgery. METHODS: In a retrospective cohort study, a total of 239 patients undergoing cardiac surgery with cardiopulmonary bypass at a tertiary medical center were included. General anesthesia consisted of volatile anesthetic and either intravenous loading of high-dose nitroglycerin (infusion rate 10 to 20 mg·h with a total dose of ≥0.5 mg·kg) starting from rewarming of cardiopulmonary bypass throughout the end of the surgery (NTG group; N = 96) or without high-dose nitroglycerin (control group; N = 143). Data for intraoperative cerebral saturation and serum creatinine concentrations before and after cardiac surgery were collected. Propensity score method was used to adjust for potential confounders. RESULTS: Patients receiving high-dose nitroglycerin had significantly lower mean arterial pressure and hematocrit levels during and after cardiopulmonary bypass. The risk of intraoperative cerebral desaturation was left-sided 23.9% versus 38.5% (p = 0.023), right-sided 28.1% versus 35.7% in the NTG and control groups, respectively. The risk of new-onset stroke and postoperative dialysis was 2.1% versus 6.3% and 1.0% versus 3.5% in the NTG and control groups, respectively. CONCLUSION: An infusion of high-dose nitroglycerin initiating at rewarming of cardiopulmonary bypass and throughout the postbypass interval may induce hypotension and hemodilution in cardiac surgical patients. Cerebral saturation and renal function were well maintained without increasing the risk of stroke and renal replacement therapy after cardiac surgery with cardiopulmonary bypass.


Assuntos
Encéfalo/efeitos dos fármacos , Procedimentos Cirúrgicos Cardíacos , Nitroglicerina/farmacologia , Pontuação de Propensão , Adulto , Idoso , Pressão Arterial/efeitos dos fármacos , Encéfalo/metabolismo , Ponte Cardiopulmonar , Feminino , Humanos , Rim/efeitos dos fármacos , Rim/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
Sci Rep ; 8(1): 13345, 2018 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-30190571

RESUMO

Whether blood transfusion exacerbates cancer outcomes after surgery in humans remains inconclusive. We utilized a large cohort to investigate the effect of perioperative blood transfusion on cancer prognosis following colorectal cancer (CRC) resection. Patients with stage I through III CRC undergoing tumour resection at a tertiary medical center between 2005 and 2014 were identified and evaluated through August 2016. Propensity score matching was used to cancel out imbalances in patient characteristics. Postoperative disease-free survival (DFS) and overall survival (OS) were analysed using Cox regression model. A total of 4,030 and 972 patients were analysed before and after propensity score matching. Cox regression analyses demonstrated blood transfusion associated with shorter DFS and OS before and after matching (hazard ratio: 1.41, 95% CI: 1.2-1.66 for DFS; 1.97, 95% CI: 1.6-2.43 for OS). Larger transfusion volume was linked to higher overall mortality (≤4 units vs. nil, HR = 1.58; >4 units vs. nil, HR = 2.32) but not more cancer recurrence. Preoperative anemia was not associated with decreased survival after adjusting covariates. Perioperative blood transfusion was associated with worse cancer prognosis after curative colorectal resection, independently of anemia status. Strategies aimed at minimizing transfusion requirements should be further developed.


Assuntos
Transfusão de Sangue , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/cirurgia , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Taxa de Sobrevida
14.
PLoS One ; 13(7): e0200893, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30028851

RESUMO

Retrospective clinical studies showed perioperative epidural analgesia (EA) was associated with better postoperative oncologic outcomes in patients with specific types of non-metastatic cancers. This study aimed to investigate the effects of EA on cancer prognosis after surgical intervention for stage IV colorectal cancer. In this retrospective study, patients with stage IV colorectal cancer undergoing primary tumor resection and metastasectomy between January 2005 and December 2014 were classified into two groups based on their use of perioperative EA or not and evaluated through August 2016. Primary and secondary endpoints were postoperative progression-free survival (PFS) and overall survival (OS), respectively. A total of 999 patients were included and 165 (16.5%) of them received EA. The median follow-up interval was 17.5 months and no significant difference in PFS or OS was noted between the EA and non-EA groups in the univariate analysis. Multivariable Cox proportional hazards model identified four independent risk factors both for disease progression and mortality, including American Society of Anesthesiologists (ASA) physical status ≥ 3, higher pretreatment carcinoembryonic antigen (CEA), multiple distant metastases, and pathologic lymphovascular invasion. After adjustment for the selected risk factors, the effects of EA on PFS and OS remained non-significant (hazard ratio: 1.06, 95% CI: 0.87 to 1.29, for PFS and 0.90, 95% CI: 0.68 to 1.20 for OS). Similar findings were demonstrated by propensity score analysis. Our results did not support the association between perioperative epidural analgesia and better progression-free or overall survival in patients following stage IV colorectal cancer surgery.


Assuntos
Analgesia Epidural , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Progressão da Doença , Idoso , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/mortalidade , Feminino , Humanos , Masculino , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos
15.
J Thorac Dis ; 9(10): E903-E906, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29268432

RESUMO

There is no current consensus on which lumen an airway exchange catheter (AEC) should be passed through in double-lumen endotracheal tube (DLT) to exchange for a single-lumen endotracheal tube (SLT) after thoracic surgery. We report an unusual case to provide possible solution on this issue. A 71-year-old man with lung adenocarcinoma had an event of a broken exchange catheter used during a DLT replacement with a SLT, after a video-assisted thoracic surgery. The exchange catheter was impinged at the distal tracheal lumen and snapped during manipulation. All three segments of the catheter were retrieved without further airway compromises. Placement of airway tube exchanger into the tracheal lumen of double-lumen tube is a potential contributing factor of the unusual complication. We suggest an exchange catheter be inserted into the bronchial lumen in optimal depth with the adjunct of video laryngoscope, as the safe method for double-lumen tube exchange.

16.
Sci Rep ; 7(1): 10816, 2017 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-28883624

RESUMO

Whether opioid use in cancer surgery would promote tumor dissemination in humans is inconclusive. We investigated the effect of intraoperative fentanyl dose on colorectal cancer (CRC) prognosis following resection in this retrospective study. A total of 1679 patients with stage I-III CRC undergoing tumor resection between January 2011 and December 2014 were evaluated through August 2016. Postoperative recurrence-free survival (RFS) and overall survival (OS) were analyzed using Cox regression models. Multivariable Cox regression analysis demonstrated no dose-response association between the amount of fentanyl dose and RFS (adjusted hazard ratio: 1.03, 95% CI: 0.89-1.19) or OS (adjusted hazard ratio: 0.84, 95% CI: 0.64-1.09). Patients were further classified into the high- and low-dose groups by the median of fentanyl dose (3.0 µg·kg-1), and there was no significant difference in RFS or OS between groups, either (adjusted hazard ratio: 0.93, 95% CI: 0.74-1.17 for RFS; 0.79, 95% CI: 0.52-1.19 for OS). We concluded that intraoperative fentanyl consumption has no impact on recurrence-free or overall survival in patients after curative CRC resection.


Assuntos
Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/cirurgia , Fentanila/administração & dosagem , Fentanila/efeitos adversos , Neoplasias Colorretais/mortalidade , Humanos , Incidência , Recidiva , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
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