Neoplasms

Digestive System Diseases

All Conditions

Liver Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Liver Diseases

Central Nervous System Depressants

All Drugs and Chemicals

Anesthetics

Propofol

Desflurane

Hypnotics and Sedatives

Anesthetics, Intravenous

Anesthetics, General

Anesthetics, Inhalation

Maintence of anesthesia during the operation using target control infusion with propofol 1mg/ml with bispetral index(BIS) in the range 40-60.

Maintence of anesthesia during the operation using inhalational agent desflurane with 0.5 to 1.5 minimal alveolar concentration (MAC) with bispetral index(BIS) in the range 40-60.

Maintence of anestheisa with propofol guided by the bispectral index in the range 40-60.

Maintence of anestheisa with desflurane guided by the bispectral index in the range 40-60.

Kuang-Cheng Chan, M.D.,PhD.

Kuang-Cheng Chan, M.D.,PhD

Hepatectomies are performed for the treatment of hepatic tumors and livingdonor liver transplantation. The success of liver resection relies on the remnant liver's ability to regenerate after major tissue loss. Despite appropriate liver remnant volume after resection ensures the liver's ability to regenerate, regeneration progresses at variable ratesin patients.

Many researches have established a relationship between the gut microbiome and patients with liver disease such as liver cirrhosis, alcoholic liver disease and obesity related liver diseases. These liver disorders are associated with bacterial overgrowth, dysbiosis, and increased intestinal permeability. However, the relationship between hepatectomy and microbiota has not been fully investigated.

The measurement of small-molecule metabolites has been an integral part of clinical practice including the familiar clinical standards like glucose and creatinine. Metabolomics, however, is able to measure all the metabolites at once. It is possible to get a far more comprehensive picture of what is happening to a patient's physiology or metabolism. Although gut microbiota has been shown to be related to liver disease and liver regeneration. Obtaining a more comprehensive analysis by identifying not only the microbial composition but also the metabolites will be more insightful.

Many routine perioperative aspects of surgical care can impact the state of the microbiome and therefore can impact clinical outcomes, like bowel preparation and antibiotics. Potential factors affecting the gut microbiota also include perioperative manipulation, stress released hormones, and opioids. Maintenance of proper anesthetic depth is beneficial to attenuate surgical stress. General anesthesia including volatile anesthetics and opioids, is associated with altered gut microbiota which might in turn affect liver regeneration. In this regard, perioperative care such as anesthesia, is one of the key points for the success of a liver resection. However, which anesthetic method is preferable regarding postoperative outcome or recovery is controversial.

In this study, the study population will include liver tumor resection and living donor hepatectomy. We aimed to 1) identify the relationship of hepatectomy and changes of gut microbiota and metabolomics. 2) investigate the impact of different anesthetic methods on the interaction of gut microbiota and metabolomics.

Anesthesia on Gut Microbiota and Metabolomics

The Impact of Different Anesthetic Methods on the Interaction of Gut Microbiota and Metabolomics Following Hepatectomy

Changes of metabolites in serum measured by metabolomic mass spectrometry

I-FEED scoring system for postoperative gastrointestinal function:

1. Intake(score): tolerating oral diet(0), limited tolerance(1), complete Intolerance(3)
2. Feeling nauseated(score): none(0), responsive to treatment(1), resistant to treatment(3)
3. Emesis(score): none(0), ≧1 episode of low volume(\<100mL) and none bilious(1), ≧1 episode of high volume(\>100mL) or bilious(3)
4. Exam(score): no distension(0), distension without tympany(1), significant distension with tympany(3)
5. Duration of symptoms(score):0-24hours(0),24-72hours(1),\>72hours(2)

Total score: 0-2 normal, 3-5 postoperative GI intolerance, \>6 postoperative GI dysfunction

National Taiwan University Hospital

Symptoms and General Pathology

Postoperative Complications

Pain, Postoperative

Pain

Analgesics

Ropivacaine

Morphine

Anesthetics, Local

Analgesics, Opioid

Analgesics, Non-Narcotic

Ropivacaine is instillated through one multi-hole catheter wich would be inserted percutaneously in all patients and tunnelled about 1-2 cm lateral to the abdominal incision and the tip of the catheter placed in the intra-peritoneal cavity. The catheter would not be ligated and fixed in situ intra-peritoneally. Twenty ml of Ropivacaine would be injected subcutaneously along both sides of the incision prior to skin closure. Additionally, 20 ml of Ropivacaine (1mg/mL) would be injected every hour by an automatic pump via the intra-peritoneal catheter into the abdomen.

Saline is instillated through one multi-hole catheter wich would be inserted percutaneously in all patients and tunnelled about 1-2 cm lateral to the abdominal incision and the tip of the catheter placed in the intra-peritoneal cavity. The catheter would not be ligated and fixed in situ intra-peritoneally. Twenty ml of Saline would be injected subcutaneously along both sides of the incision prior to skin closure. Additionally, 20 ml of Saline would be injected every hour by an automatic pump via the intra-peritoneal catheter into the abdomen.

Saline

Sven-Egron Thorn, MD PhD

Anil Gupta, MD PhD

Sven-Erik Ricksten, MD PhD

Can perioperative administration of intra-peritoneal local anaesthetics further reduce postoperative pain, inflammation and outcome in patients undergoing major abdominal surgery (cytoreductive surgery) and managed with thoracic epidural analgesia? - Multicenter study.

The aim of this study is to measure the efficacy of local anesthetics (LA) administered into the intra-peritoneal cavity compared to placebo. Our hypothesis is that the injection of local LAs intra-peritoneally would reduce post-operative pain and the inflammatory process caused by the massive release of cytokines during extensive cytoreductive surgery. The study is a controlled, parallel group, double blind, prospective, randomized and performed at Sahlgrenska University Hospital in Goteborg, Sweden . Twenty mL of ropivacaine or saline would be injected every hour by an automatic pump via the intra-peritoneal catheter into the abdomen according to group randomization in order to double blind patients and all personnel involved in the study.

The parameters that would be evaluated are inflammatory markers, postoperative morbidity, pain intensity, consumption of morphine, cognitive function and progression-free survival.

Intra-Peritoneal Local Anaesthesia After Cytoreductive Surgery

Peroperative Analgesia Following Cytoreductive Surgery. A Randomized, Double-blind, Comparison Between Intra-peritoneal Local Anesthesia and Placebo - Multicenter Study

Analysis of the following inflammatory markers with Multiplex: IL(interleukin)-1β, IL-1rα, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10, IL-12 (p70), IL-13, IL-15, IL-17A, zBasic FGF (Fibroblast Growth Factor), Eotaxin, G-CSF (granulocyte colony stimulating factor), GM-CSF granulocyte macrophage colony stimulating factor), IFN-γ (interferon), IP-10 (immune protein), MCP-1 (monocyte chemotactic protein), MCAF (monocyte chemotactic and activating factor), MIP-1α (macrophage inflammatory protein), MIP-1β, PDGF-BB (platelet-derived growth factor), RANTES (regulated on activation, normal T cell expressed and secreted), TNF-α (tumor necrosis factor), VEGF (vascular endothelial growth factor)

Total amount of Morphine consumed during the first 48 hours after surgery

Pain Intensity is measured with Numeric Rating Score 0-10

Patients will complete the following neurophysiological tests upon entering the study and within one month after surgery: Verbal Learning Test (VLT), Concept Shifting Test (CST), Letter-Digit Coding, Verbal Learning Test - Delayed Recall (VLT-D)

Progression-free Survival measures the length of time after treatment during which the cancer being treated does not get worse.

Measuring the numbers of Postoperative Morbidity/Complications within one month after surgery:

Morbidity:

* Local infections
* Urinary infection (urine culture)
* Pneumonia (X-ray, C-reactive protein, Fever)
* Sepsis (Fever, Leucocyte count in blood, Heart Rate, Respiratory Rate)
* Pleural fluid (X-ray verified)
* Deep Vein Thrombosis (D-dimer, ultrasound verified)
* Pulmonary embolism (Computed Tomography/ Scint-X)
* Acute Myocardial Infarction (Electrocardiography, Troponin I)
* Atrial fibrillation or serious arrhythmia during the first 48 hours after surgery (Electrocardiography)
* Respiratory failure (prolonged mechanical ventilation)
* Renal failure (Serum Creatinine, Diuresis, AKIN criteria)
* Inotropic needs \> 12 hours after surgery

Surgical Complications:

* Intraabdominal bleeding
* Leakage from anastomosis
* Abdominal abscess
* Paralytic ileus
* Pancreatic leakage (requiring drainage)

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Anesthesia on Gut Microbiota and Metabolomics	NCT04767503	Hepatic Tumor R...	Propofol Desflurane	20 Years - 75 Years	National Taiwan University Hospital
Anesthesia on Gut Microbiota and Metabolomics	NCT04767503	Hepatic Tumor R...	Propofol Desflurane	20 Years - 75 Years	National Taiwan University Hospital
Intra-Peritoneal Local Anaesthesia After Cytoreductive Surgery	NCT02256228	Pain	Ropivacaine Saline	18 Years - 74 Years	Göteborg University

Spots Global Cancer Trial Database for anesthetic

Every month we try and update this database with for anesthetic cancer trials from around the world to help patients and their families find trials that might be right for them.
We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.

Spots Global Cancer Trial Database for anesthetic

Every month we try and update this database with for anesthetic cancer trials from around the world to help patients and their families find trials that might be right for them. We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.

Every month we try and update this database with for anesthetic cancer trials from around the world to help patients and their families find trials that might be right for them.
We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.