Neoplasms

Urinary Tract, Sexual Organs, and Pregnancy Conditions

All Conditions

Urologic Neoplasms

Urogenital Neoplasms

Urogenital Diseases

Female Urogenital Diseases

Pregnancy Complications

Female Urogenital Diseases and Pregnancy Complications

Male Urogenital Diseases

Urologic Diseases

Central Nervous System Depressants

All Drugs and Chemicals

Anesthetics

NLR and PLR ratio will be assessed at postoperative 6th and 24th hours compared to preoperative values

INHA

TIVA

Cancer is a major cause of morbidity and mortality worldwide. Despite the use of surgery in an attempt to cure the majority of solid tumors, metastasis from residual cancer cells still remains a major cause of morbidity and mortality. General anesthesia and surgical stress during surgery suppress the immune response by directly affecting the immune system or by activating the hypothalamic-pituitaryadrenal axis and the sympathetic nervous system. The aim of our prospective observational study was to assess the value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio regarding outcome underwent cancer surgery. Primary aim is to assess the preoperative and postoperative values of inhalational anesthesia vs total intravenous anesthesia.

Cancer is a major cause of morbidity and mortality worldwide. Despite the use of surgery in an attempt to cure the majority of solid tumors, metastasis from residual cancer cells still remains a major cause of morbidity and mortality. As is the case with most cancers, loco-regional recurrence and distant metastases are all too common, even after successful surgical treatment and adjuvant therapy. Cancer metastasis is a complex process in which cancer cells evade the immune system. Cancer cells gain the ability to proliferate, migrate, and invade adjacent tissues, and together with angiogenesis, these capabilities facilitate the successful metastasis of cancer.

General anesthesia and surgical stress during surgery suppress the immune response by directly affecting the immune system or by activating the hypothalamic-pituitaryadrenal axis and the sympathetic nervous system. Along with surgical stress, blood transfusion, hypothermia, and postoperative pain, anesthetics are associated with immunosuppression during perioperative periods because anesthetics/analgesics have direct suppressive effects on cellular and humoral immunity. In general anesthesia, it is suggested that inhalational anesthesia (INHA) such as sevoflurane and isoflurane may modulate antimetastatic immunity by inhibiting NK cell cytotoxicity and inhibit T helper cell proliferation. This could potentially be unfavorable for cancer survival. In contrast, propofol-based total intravenous anesthesia (TIVA) is suggested to have anti-inflammatory features and to be advantageous compared with INHA by promoting the activation of T-helper cells, decreasing matrix metalloproteinases, and not suppressing NK cell activity to the same extend as INHA. The immunological impact of the anesthetic agents may thus influence clinical measures including overall mortality and postoperative recovery. Recently, some readily available parameters, originated from routine complete blood count (CBC), have been investigated as potential biomarkers with mixed results and no consensus so far regarding its accuracy and clinical usefulness: neutrophil-to-lymphocyte ratio (NLR), monocyte-to lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume-to-platelet count (MPV/PC) ratio.

The aim of our prospective observational study was to assess the value of NLR and PLR ratio regarding outcome underwent cancer surgery. Primary aim is to assess the preoperative and postoperative values of inhalational anesthesia vs total intravenous anesthesia.

Platelet-lymphocyte and Neutrophil-lymphocyte Ratio in Patients Undergoing Cancer Surgery

The Effect of Different Anesthesia Methods on the Platelet-lymphocyte and Neutrophil-lymphocyte Ratio in Patients Undergoing Cancer Surgery

Primary aim is to assess the preoperative and postoperative values of inhalational anesthesia vs total intravenous anesthesia.

Medipol University

Principal Investigator

Skin and Connective Tissue Diseases

Symptoms and General Pathology

Breast Neoplasms

Pain

Analgesics

Propofol

Remifentanil

Desflurane

Hypnotics and Sedatives

Anesthetics, Intravenous

Anesthetics, General

Anesthetics, Inhalation

The patients will recieve intravenous anesthesia (propofol-remifentanyl)

Recommended dosage:

Propofol: Induction dosage 1,5-2,5 mg/kg Remifentanyl: Induction dosage 0,5-1μg/min The preservation dosage will depend from patients' body weight, body height and BMI

The patients will recieve volatile anesthesia (desflurane-remifentanyl)

Recommended dosage:

Desflurane dosage 6-7 MAC Remifentanyl: Induction dosage 0,5-1μg/min The preservation dosage will depend from patients' body weight, body height and BMI

Patients will be divided into 2 groups. The TIVA group (N = 23) will be administrated intravenous anesthesia (propofol-remifentanil), while to the DES group (N = 23) volatile anesthetics (desflurane-remifentanil)

Evangelos Konstantinou, RN, PhD

The aim of the present study is to investigate the effect of intravenous anesthetics versus the administration of volatile anesthetics on stress and pain levels during autologous fat transfer for breast reconstruction in a Day Care Center.

The sample of the study will be patients who will have Autologous Fat Transfer for Breast Reconstruction.

Patients will be divided into 2 groups. The TIVA group (N = 23) will be administrated intravenous anesthesia (propofol-remifentanil), while the DES group (N = 23) volatile anesthetics (desflurane-remifentanil).

Specifically, the TIVA group will include patients over 50 years of age with high risk of nausea / vomiting and postoperative delirium, as well as suspicion of malignant hyperthermia. Patients with cardiac and respiratory problems will be included in the DES group.

The following data will be collected in the Data Sheet: Patient Demographics (Gender, Age), Body Mass Index (Body Height- Body Weight). Simultaneously, the pain levels will be evaluated by VAS Optical Analogue Scale of VAS 0-10 in PACU, preoperatively and postoperatively, and perioperative pain levels will be assessed with CPOT scale (values 0-8).

Stress levels will be evaluated with 3 NAS questions: a. How sad do you feel right now? b. How anxious do you feel right now? and c. How optimistic do you feel right now?. The 3 NAS questions will also be given preoperatively and postoperatively to the ward. The sedation levels will be assessed by RASS scale (values +4 to -5) and the Bispectral Index (BIS). The level of patient's awareness will be assessed by GCS Scale (3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (more widely used modified or revised scale)).

The presence or absence of nausea / vomiting and the appearance of immediate postoperative complications will be examined. Finally, post-operative stress will be examined with stress biomarkers, salivary ACTH hormone and salivary cortisol hormone.

TIVA Admnistration and Autologous Fat Transfer in Breast Reconstruction

TIVA Versus Volatile Anesthetics Admnistration on Stress and Pain Levels During Autologous Fat Transfer in Breast Reconstruction, in a Day Care Center

Analyzing Cortisol and Adrenocorticotropic hormones levels in salivary samples.

Analyzing Cortisol and Adrenocorticotropic hormones levels in salivary samples in patients after breast recostruction in a day care center.

These measures will occured in three phases a. preoperatively, b. perioperatively c. in the PACU phase.

Evaluating perioperative pain levels between the two protocols with scale such as Critical Care Pain Observational Tool (CPOT scale, range 0-8(with a score of 0 = None and 8 = severe pain) )

Evaluating perioperative stress levels between the two protocols with scale, such as the self-experienced questions (range0-10, (with a score of 0 = None and 10 = Completely) ) how sad are you feeling?in two phases: a. preoperatively, b) in PACU

Evaluation with Richmond Agitation-Sedation Scale (RASS scale, range +4 to -5, (with a score of -5 = unarousable and +4 = violent, immediate danger for the staff) ).

Evaluation with Bispectral index (BIS, range 0-100). A BIS score quantifies changes in the electrophysiologic state of the brain during anesthesia. In patients who are awake, a typical BIS score is 90 to 100. Complete suppression of cortical activity results in a BIS score of 0, known as a flat line. Lower numbers indicate a higher hypnotic effect. Overall, a BIS value below 60 is associated with a low probability of response to commands.

Evaluating perioperative pain levels between the two protocols with scale such as Visual analogu pain scale (VAS, range 0-10, (with a score of 0 = None and 10 = severe pain) ) in PACU

Evaluating perioperative stress levels between the two protocols with scale, such as three self-experienced questions (range0-10, (with a score of 0 = None and 10 = Completely) ) how stressed are you feeling, in two phases: a. preoperatively, b) in PACU

Evaluating perioperative stress levels between the two protocols with scale, such as three self-experienced questions (range0-10, (with a score of 0 = None and 10 = Completely) ) how optimistic are you feeling, in two phases: a. preoperatively, b) in PACU

Saint Savvas Anticancer Hospital

National and Kapodistrian University of Athens

Digestive System Diseases

Carcinoma

Carcinoma, Hepatocellular

Neoplastic Cells, Circulating

Neoplasms, Glandular and Epithelial

Neoplasms by Histologic Type

Adenocarcinoma

Liver Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Liver Diseases

Neoplasm Metastasis

Neoplastic Processes

Platelet Aggregation Inhibitors

Other Dietary Supplements

Rocuronium

Sevoflurane

Atracurium

Benzocaine

Tannic Acid

Patients in SEVO group will be anaesthetized by inhalational anaesthesia using sevoflurane.

The patients in TIVA group will be anaesthetized using total intravenous propofol.

Monitoring and other anaesthetic procedures including the management of hypertension and hypotension will be the same as SEVO group. Induction and maintenance of general anaesthesia will be conducted using total intravenous infusion of propofol. Sevoflurane will not be used, and oxygen and air would be given to provide a FiO2 of 30-50%.

Target controlled infusion (TCI) with a modified Marsh effect site model (Fresenius Kabi) will be used for induction and maintenance of general anaesthesia and titrated to effect. The usual effect site concentration is 1.5-3 mcg.ml-1 and BIS monitoring will also be used to produce a value of between 40-60. As with patients in the SEVO group, remifentanil will be infused at a rate of between 0.1-0.3 mcg.kg.min-1.

Propofol 1.5-3mg/kg, remifentanil 1mcg/kg, and rocuronium 0.6-1mg/kg or atracurium 0.5mg/kg will be used intravenously for induction of general anaesthesia. Intubation would be performed after induction of general anaesthesia. General anaesthesia monitoring will be used. Sevoflurane, air and oxygen will be used for maintenance of general anaesthesia. FiO2 will be kept between 35-50%. BIS monitoring will be applied and level of anaesthetia will be titrated to maintain a BIS value of between 40-60. Intravenous remifentanil infusion between 0.1-0.2 mcg/kg/min will be given and this will be titrated to provide optimal haemodynamic parameters.

Michael G. IRWIN, M.B. Ch.B

Amulet CM Ip, BSN

Chong

Michael G. Irwin, M.B. Ch.B

More than 80% of patients with cancer will be exposed to anaesthesia at some point in their treatment. There is increasing evidence that perioperative events, including the type of anaesthesia drugs utilised, have an impact on cancer recurrence and metastases.

Although potentially and theoretically curative, surgical resection, manipulation and trauma may disseminate tumour cells and reduce immunity. There have been a number of suggestions as to why cancer may be, paradoxically, worsened by surgery and what methods may be used to mitigate this. One of these is propofol based total intravenous anaesthesia (TIVA), whereby the traditional inhalational anaesthetic drugs are avoided. Commonly used inhalational drugs, such as sevoflurane and desflurane, are pro-inflammatory.

Propofol, however, has anti-inflammatory and anti-oxidative properties, induces apoptosis and has specific inhibitory effects on tumour cell growth in vitro. Laboratory investigations, animal models, retrospective clinical studies and initial clinical research are producing evidence that inhalational anaesthesia facilitates tumour recurrence and metastasis, whilst TIVA can prolong survival.

This randomised, controlled trial will look at the effects on DNA damage and biomarkers of immunity and inflammation of inhalational anaesthesia versus TIVA in patients undergoing surgery for hepatocellular carcinoma, a common tumour in the Southern Chinese population, for whom surgery is potentially-curative. It will focus on subjects undergoing open and laparoscopic hepatectomy and investigate changes in biomarkers of inflammation, immunity and gene expression from the patients' blood samples taken before, during and after surgery.

Patients will also be followed-up for cancer recurrence, morbidity and five-year mortality. Results could represent a breakthrough in knowledge of how anaesthetic agents impact the results of cancer surgery, and have important implications for a more disease- sensitive approach to improving management and outcomes in these patients.

Pre-operative care

Pre-operative assessment will be performed at the preadmission clinic or at the general ward. Patients will be fasted for intake of solid food for 6 hours and clear liquids for 2 hours. Sedative premedication will not be prescribed.

Anaesthesia and intraoperative care

SEVO Group

Patients from the SEVO group will be anaesthetized according to the following protocol:

On arrival at the operation theatre, an intravenous cannula will be inserted. Standard monitoring with pulse oximeter, non-invasive blood pressure, and three-lead electrocardiogram will be applied prior to induction. Non-invasive blood pressure (NIBP) will be checked at least every 5 minutes throughout the operation. An arterial line may be inserted at the discretion of the anaesthetist before or after induction, with invasive blood pressure monitoring in lieu of NIBP if deemed necessary. Additional intravenous cannulas or central lines may also be inserted to facilitate fluid therapy, measure the central venous pressure or administer drugs, also at the discretion of the attending anaesthetist.

Anaesthesia will be induced with titrated, manual propofol injection of 1-2 mg.kg-1. Remifentanil infusion will be given for analgesia at a rate of 0.1 - 0.35 mcg.kg.min-1 as required, according to haemodynamic parameters. Cisatracurium 0.15 mg.kg-1 or atracurium 0.5 mg.kg-1 will be used for muscle relaxation. Tracheal Intubation will be performed after induction of general anaesthesia. General anaesthesia monitoring will be used. Sevoflurane at 0.5- 1 MAC, air and oxygen will be used for maintenance of general anaesthesia. Processed EEG (BIS™) will be utilized to monitor depth of anaesthesia, aiming at a BIS value of 40-60. FiO2 will be kept between 35-50% to maintain and SaO2 of \> 95%. Further muscle relaxants can be given during the operation if required.

In accordance with British consensus guidelines on intravenous fluid therapy for Adult Surgical Patients \[22\], intraoperative fluid or blood loss will be initially replaced with balanced crystalloid solution, preferably Plasmalyte A (a physiologically balanced electrolyte solution similar to extracellular fluid), for up to 20% of body volume, with additional fluid replacement with colloid or crystalloid at the discretion of the anaesthetist. Intravenous phenylephrine, ephedrine or fluid administration may also be given for management of hypotension. Intravenous anti-hypertensive agents such as beta blockers (e.g. esmolol, labetalol) and glyceryl trinitrate can be given if hypertension occurs.

Patients will receive standardized opioid analgesia of 0.1 mg.kg-1 intravenous morphine intra-operatively followed by patient-controlled analgesia (PCA) morphine post-operatively, as well as local anaesthesia (0.5% levobupivacaine) injected in the areas of surgical incision during wound closure for pain control.

Forced air warming blankets will be used with the aim of keeping a core temperature of 35.5-37.5 degrees Celsius. Ondansetron 4mg IV will be given 30 minutes before end of surgery.

Sevoflurane and remifentanil infusion will be switched off at the end of the procedure. Reversal of muscle relaxation can be achieved if required with neostigmine 50 mcg.kg-1 IV and atropine 20 mcg.kg-1 IV. Patients will subsequently be transferred to the post anaesthetic care unit (PACU) for monitoring for at least 30 minutes.

TIVA Group

Patients in the TIVA group will be anaesthetized according to the following protocol:

Monitoring and other anaesthetic procedures including the management of hypertension and hypotension will be the same as SEVO group. Induction and maintenance of general anaesthesia will be conducted using total intravenous infusion of propofol. Sevoflurane will not be used, and oxygen and air would be given to provide a FiO2 of 30-50%.

Target controlled infusion (TCI) with a modified Marsh effect site model (Fresenius Kabi) will be used for induction and maintenance of general anaesthesia and titrated to effect. The usual effect site concentration is 1.5-3 mcg.ml-1 and BIS monitoring will also be used to produce a value of between 40-60. As with patients in the SEVO group, remifentanil will be infused at a rate of between 0.1-0.3 mcg.kg.min-1.

Post-operative care for both groups In the recovery room after surgery, numerical rating pain score (NRS) will be used to assess level of pain. Patients will select a whole number (0-10 integers) that best reflects the intensity of his/her pain, in which 10 represents the maximal imaginable pain. Boluses of 2 mg intravenous morphine will be given every 5 minutes until the numerical rating scale (NRS) is less than or equal to 4/10. A patient controlled analgesia (PCA) machine will then be connected. The machine will be configured to give 1 mg of morphine whenever the patient demands with the lockout duration set to 5 minutes. No background infusion will be given and the maximum dose limit will be 0.1 mg.kg-1 per hour of morphine.

On post-operative day 1, when the patient resumes a fluid diet, oral celecoxib 200 mg will be given twice daily for 3 days.

Whilst on PCA morphine, the patient's respiratory rate, oxygen saturation (SpO2) and sedation score will be monitored every hour. Heart rate and blood pressure will be checked every 4 hours. NRS pain scores at rest and during cough/movement, cumulative PCA morphine doses, and number of PCA demands/goods delivered, and side effects (nausea, vomiting, dizziness, hypotension, desaturation) will be recorded every 4 hours. Patients will be assessed by a "pain team" every day to determine sufficiency of analgesia, as per usual practice.

Patients will be kept on PCA morphine for at least 2 days. If NRS pain scores during cough/ movement on postoperative day 2 are less than or equal to 3/10, PCA morphine will be stopped. PCA morphine will be continued if NRS is equal or greater than 4, or if the patient remains on a high PCA use. Assessment for analgesia will be conducted daily. Evaluation for complications will be required if NRS pain score is 4 or higher on postoperative day 5. The patient will be further managed at the discretion of the anaesthetist.

After PCA morphine has been withdrawn, NRS pain scores at rest and during cough/ movement, as well as the dose and frequency of rescue analgesia used will be charted once a day until discharge.

Effects of TIVA Versus Inhalational Anaesthesia on Circulating Tumour Cells in Hepatocellular Carcinoma Patients

Effects of Mode of Anaesthesia on Circulating Tumour Cells in Patients Undergoing Inhalational Versus Total Intravenous Anaesthesia for Hepatocellular Carcinoma Surgery : A Randomised Controlled Trial

the detection of a two-fold difference between the pre-operative blood sample and 24-hour post-operative blood sample in HIF-1 gene expression in the SEVO group, and a less than two-fold difference in the same samples of the TIVA group

Change in the incidence of two-year recurrence between TIVA and SEVO group

The level of Gene expression (HIF-1, IL-6, TNF-alpha) will be measured from the RNA/cDNA extracted from blood sample taken at different timepoints by Polymerase chain reaction test

The level of DNA damage will be measured from the white blood cells extracted from blood sample taken at different timepoints by Comet Assay test

The level of C-reactive protein will be measured from the Plasma extracted from blood sample taken at different timepoints by Commercial Kit

The level of Glutathione Peroxidase will be measured from the Red blood cells extracted from blood sample taken at different timepoints by Commercial Kit

The level of Superoxide dismutase will be measured from the Red blood cells extracted from blood sample taken at different timepoints by Commercial Kit

The level of Oxidative damage DNA (8-oxoGuo, 8-oxodG) will be measured from the Plasma extracted by Commercial Kit

The level of tumor necrosis factor (IL-6, TNF-alpha, HIF-1) will be measured from the Plasma extracted by An enzyme-linked immunosorbent assay (ELISA)

The number of Circulating tumour cells will be isolated from the blood samples taken at different timepoints by filtration and count under microscope

The University of Hong Kong

Anti-Arrhythmia Agents

Channel Blockers

Adjuvants, Anesthesia

Lidocaine

Fentanyl

Ketamine

Isoflurane

Narcotics

Induction with 1% propofol (2-3 mg/kg), fentanyl (1-3 mg/kg), and Rocuronium 1-1.5 mg/kg. Before the injection of propofol, 5 mL 1% lidocaine (50 mg) to limit any discomfort caused by the propofol injection. After endotracheal intubation, intravenous infusion of propofol, lidocaine, ketamine or narcotic as deemed appropriate by anesthesiologist. There will be no inhalation anesthetic used. Ventilation with oxygen and air mixture (50%/50%) and titrated to keep the mean arterial pressure within 20% of its preinduction value. Muscle relaxation maintain using Aliquots of rocuronium to 0 to 1 train-of-4 twitch response of adductor pollicis. During surgery, mechanical ventilation using pressure-controlled mode (peak inspiratory pressure 30 cm H2O). We aim for Tidal volume of 5-7 ml/Kg of ideal body weight with a positive end-expiratory pressure of 5 cm H2O, and a respiratory rate to maintain end-tidal carbon dioxide between 30 to 40 mm Hg.

Induction with 1% propofol (2-3 mg/kg), fentanyl (1-3 mg/kg), and Rocuronium 1-1.5 mg/kg. Before the injection of propofol, 5 mL 1% lidocaine (50 mg) to limit any discomfort caused by the propofol injection. After endotracheal intubation, the depth of anesthesia will be maintained at a minimum alveolar concentration of 1 to 1.25 using isoflurane in oxygen and air mixture (50%/50%) and titrated to keep the mean arterial pressure within 20% of its preinduction value. Muscle relaxation maintain using Aliquots of rocuronium to 0 to 1 train-of-4 twitch response of adductor pollicis. During the surgery, subjects will be mechanically ventilated using pressure-controlled mode (peak inspiratory pressure 30 cm H2O). We aim for Tidal volume of 5-7 ml/Kg of ideal body weight with a positive end-expiratory pressure of 5 cm H2O, and a respiratory rate to maintain end-tidal carbon dioxide between 30 to 40 mm Hg.

Induction with 1% propofol (2-3 mg/kg), fentanyl (1-3 mg/kg), and Rocuronium 1-1.5 mg/kg. Before the injection of propofol, 5 mL 1% lidocaine (50 mg)

Induction with 1% propofol (2-3 mg/kg), fentanyl (1-3 mg/kg), and Rocuronium 1-1.5 mg/kg. Before the injection of propofol, 5 mL 1% lidocaine (50 mg

Balanced anesthesia

Sonia Mehta, MD

Anna Woods

Steep Trendelenburg positioning and insufflation of the abdominal cavity have shown to increase intra ocular pressure. Different anesthetic techniques can alter intra ocular pressure and a small pilot study showed decrease in Intraocular Pressure (IOP) in robotic case in steep Trendelenburg with IV anesthetics (TIVA).

We want to quantify the degree of change in Intraocular Pressure (IOP) in female patients undergoing robotic procedures for cancer. We want to detect the difference in increase of pressure with total IV anesthesia versus conventional balanced anesthesia

During the day of surgery, the anesthesiologist trained by an ophthalmologist, will measure each eye's Intraocular Pressure (IOP) using a tonometer for both the Trendelenburg with IV anesthetics (TIVA) and propofol/fentanyl/rocuronium arms of the study. (The Tono-Pen XL Medtronic Solan, Jacksonville, FL) The Intraocular Pressure (IOP) for both eyes will be measured at seven time points:

Time 1 induction after administration of sedative and local anesthesia in the eye. Both eyes of the patient will anesthetized using topical proparacaine hydrochloride ophthalmic solution 0.5%.

Time 2 Post induction table 0 degrees Time 3 Supine after pneumoperitoneum with 14 mmHg pressure Time 4 After docking robot at correct Trendelenburg positioned measured by a level Time 5 After undocking and before moving supine Time 6 Supine and before extubation. If the intraocular pressure remains elevated above 19 mmHg will require a 7th measurement in PACU with HOB at 30 degrees and if the pressure still at or above 19 ophthalmology consult initiated.

Time 7 if needed, see above

If the patient has any increased reading at the end of the procedure, the same attending anesthesiologist in the post-operative recovery area prior to discharge will do a post op measurement. Any abnormal readings will prompt an ophthalmology consult and follow up with ophthalmology department.

Effect of Position and Anesthetic Choice in Intraocular Pressure in Robotic GYN (Gynecologic) Oncology Patients

quantify the degree of change in IOP in female patients undergoing robotic procedures for cancer

University of Florida

Colorectal Neoplasms

Intestinal Neoplasms

Colonic Diseases

Intestinal Diseases

Rectal Diseases

Anesthetics, Local

Sodium Channel Blockers

Diuretics, Potassium Sparing

TIVA-L. Patients allocated to receive TIVA (propofol-fentanyl) with lidocaine infusion.

Interventions: TIVA+lidocaine

TIVA-P. Patients allocated to receive TIVA without lidocaine (placebo). Intervention: TIVA+placebo (saline infusion)

Sevo-P. Patients allocated to receive Sevoflurane anesthesia without lidocaine infusion (placebo).

Intervention: sevoflurane anesthesia +placebo (saline infusion)

Sevo-L. Patients allocated to receive sevoflurane anesthesia with lidocaine infusion for the first 48 h postoperatively.

Intervention: sevoflurane anesthesia+ lidocaine infusion

Patients will be subjected to total intravenous anesthesia with propofol-fentanyl+i.v. lidocaine infusion for the first 48 h postoperatively

TIVA+lidocaine

Patients will be subjected to anesthesia with sevoflurane- fentanyl + lidocaine infusion for the first 48 h postoperatively.

Sevoflurane+lidocaine

Patients will be subjected to TIVA with propofol-fentanyl + saline infusion for the first 48 h postoperatively

TIVA+placebo

Patients will be subjected to anesthesia with sevoflurane-fentanyl + saline infusion for the first 48 h postoperatively

Sevoflurane+placebo

Daniela IONESCU, Prof

Alexandru Alexa, Assist Prof

Daniela Ionescu, Prof

Alexa Alexandru, Assit Prof

Tiberiu Tat, PhD student

Alexandru Alexa, PhD student

Tiberiu Tat, doctor

Study aims to compare the influence of TIVA and sevoflurane anesthesia with or without lidocaine on postoperative short and long term outcome in patients with colorectal cancer undergoing surgery.

As short term endpoints postoperative pain and opioid consumption, resumption of bowel function, PONV, LOS will be registered.

Long term outcome parameters include: the incidence of chronic pain, 1 and 5 years cancer recurrences incidence and mortality.

Main goals

1. Comparative evaluation of the incidence of recurrences after TIVA vs sevoflurane anesthesia
2. Evaluation of the effect of lidocaine infusion associated with TIVA/sevoflurane on the incidence of chronic pain and of cancer recurrences and survival.

Secondary objectives

1. Evaluation of the influence of lidocaine on postoperative outcome in patients with colorectal cancer
2. Evaluation of the influence of lidocaine on postoperative inflammatory response
3. Evaluation of the influence of lidocaine on the incidence and severity of postoperative pain and outcome in patients with colorectal cancer

Anesthesia and Postoperative Outcome in Colorectal Cancer Patients

The Influence of Anesthesia on Postoperative Outcome and Complications in Colorectal Cancer Patients

An investigator will note any signs of local anaesthetics systemic toxicity at the bed site of patient

The incidence of recurrences will be registered annually and reported from the first year to 5 years respectively in all 4 groups of patients.

Total morphine consumption during the first 24h after surgery will be recorded

The severity of postoperative pain will be recorded along with morphine consumption.Pain intensity will be followed during the first 48 h postoperatively.

Time to first flatus will be registered and compared between groups.

LOS will be registered and compared between study groups.

Chronic pain at 6 month and 1 year respectively will be assessed with McGill questionnaire by telephone interview.

Scores range from 0 (no pain) to 78 (severe pain), patients with high scores need to seek medical advice

Evaluation of the influence of lidocaine on 24-hour postoperative inflammatory response; All patients will have leukocytes count and c protein reactive (PCR) so an analysis can be made.

Monitoring the incidence of some common perioperative complications: pulmonary embolism, pulmonary edema, acute kidney injury, anastomosis leak, myocardial infarction, stroke, pneumonia

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Platelet-lymphocyte and Neutrophil-lymphocyte Ratio in Patients Undergoing Cancer Surgery	NCT04630483	Cancer Urologic Neopla... Gynecologic Can...	INHA TIVA	20 Years - 75 Years	Medipol University
TIVA Admnistration and Autologous Fat Transfer in Breast Reconstruction	NCT04077827	Breast Cancer	Propofol	20 Years - 70 Years	National and Kapodistrian University of Athens
Platelet-lymphocyte and Neutrophil-lymphocyte Ratio in Patients Undergoing Cancer Surgery	NCT04630483	Cancer Urologic Neopla... Gynecologic Can...	INHA TIVA	20 Years - 75 Years	Medipol University
Effects of TIVA Versus Inhalational Anaesthesia on Circulating Tumour Cells in Hepatocellular Carcinoma Patients	NCT04601961	Circulating Tum... Hepatocellular ...	Propofol Sevoflurane	18 Years - 80 Years	The University of Hong Kong
Effect of Position and Anesthetic Choice in Intraocular Pressure in Robotic GYN (Gynecologic) Oncology Patients	NCT04281017	Intraocular Pre... Oncology	TIVA Balanced anesth...	18 Years - 99 Years	University of Florida
Anesthesia and Postoperative Outcome in Colorectal Cancer Patients	NCT02786329	Colorectal Canc...	TIVA+lidocaine Sevoflurane+lid... TIVA+placebo Sevoflurane+pla...	18 Years - 80 Years	Institutul Regional de Gastroenterologie & Hepatologie Prof. dr. Octavian Fodor
Effect of Position and Anesthetic Choice in Intraocular Pressure in Robotic GYN (Gynecologic) Oncology Patients	NCT04281017	Intraocular Pre... Oncology	TIVA Balanced anesth...	18 Years - 99 Years	University of Florida
TIVA Admnistration and Autologous Fat Transfer in Breast Reconstruction	NCT04077827	Breast Cancer	Propofol	20 Years - 70 Years	National and Kapodistrian University of Athens
Anesthesia and Postoperative Outcome in Colorectal Cancer Patients	NCT02786329	Colorectal Canc...	TIVA+lidocaine Sevoflurane+lid... TIVA+placebo Sevoflurane+pla...	18 Years - 80 Years	Institutul Regional de Gastroenterologie & Hepatologie Prof. dr. Octavian Fodor

Spots Global Cancer Trial Database for tiva

Every month we try and update this database with for tiva 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 tiva

Every month we try and update this database with for tiva 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 tiva 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.