Anesthesia Clinical Trial
Official title:
The Effects on Major Organ Complications on Esophagectomy of New Anesthetic ERAS (Enhanced Recovery After Surgery) Strategy: a Prospective Investigation
The goals of this study are to testify the effectiveness on enhancement recovery by new anesthetic ERAS (Enhanced recovery after surgery) strategy.
ERAS (Enhanced recovery after surgery) strategy is extremely important for patients
receiving esophagectomy including the preoperative preparation (smoking cessation, exercise
prescription and nutrition prescription), intraoperative management, and postoperative
analgesia and respiratory rehabilitation. However, despite the less invasive thoracoscopic
esophagectomy and laparoscopic gastric tube reconstruction was developed, respiratory
complications including acute lung injury (ALI) were observed up to 20% and associate with
50% of mortality. A new preventive anesthetic ERAS strategy including precise perioperative
fluid management and preventive management after tracheal extubation should be developed.
Previous report indicated that none of the variables studied except fluid administration
were shown as a risk factor for the development of respiratory complications on the
multivariate analysis on esophageal surgery. However, there are rare prospective
investigations of perioperative fluid administration strategy on postoperative complications
after esophagectomy. Our group has studied on goal-directed fluid optimization and we found
that the goal of optimization may differ for specific surgery. For esophagectomy, new
anesthetic ERAS strategy should include precise preoptimized circulatory management and
aggressive postoperative pulmonary care. Based on Frank-Starling law (stroke volume, SV,
response to fluid therapy), a precise goal for perioperative goal-directed fluid therapy
(GDFT) becomes possible in anesthetic practice. However, the effects of preoperative
maximization of SV remain unknown. Following our study in last year, we planned to randomize
120 esophagectomy patients in the following 3 years into different GDFT groups (SV
maximization and SV normalization groups). Postoperative THRIVE (Transnasal Humidified
Rapid-Insufflation Ventilatory Exchange) therapy will be take place immediately after
tracheal extubation. Blood samples will be obtained preoperatively to postoperative day 1 to
measure lung injuries, kidney injuries as well as the inflammatory and oxidative markers.
The clinical records will be collected (including extubation time, ICU stay, hospitalization
days, 30-day mortality, 90-day mortality, readmission, postoperative cardiovascular,
pulmonary, and renal complications, gastric tube related complications etc. ). The goals of
this study are to testify the effectiveness on enhance recovery by new anesthetic ERAS
strategy.
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