| Part One:Incidences of and cancer patients' preferences for common clinical anesthesia outcomesObjective:Propofol injection pain(PIP)is one of the most common clinical anesthesia outcomes and a concern of clinical researchers which has been adequately studied during the past decades.However,study about patients' preferences for common clinical anesthesia outcomes is relatively small.In particular,patients' opinion on propofol injection pain and the incidence of patients' recall of this brief discomfort are still unknown.Thus,the main purpose of this study is to know the cancer patients'preferences for common clinical anesthesia outcomes,especially for PIP.The secondary purpose is to provide useful information about the incidence of certain common clinical anesthesia outcomes,particularly the recall of PIP under our routine general anesthesia.Methods:Patients who were scheduled for elective open thyroidectomy under general anesthesia at National Cancer Center/Cancer Hospital were selected.The preoperative questionnaire was prepared strictly according to the questionnaire compilation steps such as reviewing and analyzing relevant literature,consulting experts,carrying out pilot experiments,conducting validity and feasibility analysis in order to form the final questionnaire.Five hundred preoperative questionnaires were distributed from May 2016 to July 2016.We used priority ranking scales to determine their preferences.Eligible patients were asked to rank ten possible clinical anesthesia outcomes associated with general anesthesia from their most undesirable(1)to their least undesirable effect(10).Patients who completed the preoperative questionnaires were asked whether they experienced clinical anesthesia outcomes and to grade the severity on the first postoperative day.We evaluated the patient's satisfaction scores on anesthesia by 0 to 10 numerical rating scale.Results:1.A total of 500 preoperative questionnaires were issued and 500 were returned with a response rate of 100%.And 448 of them were valid and analyzed with an efficient rate of 89.6%.2.Incisional pain(2.53±2.38)was ranked as most undesirable,followed(in order)by vomiting(4.21 ±2.50),gagging on the tracheal tube(4.37±2.24),nausea(4.66±2.23),sore throat(4.67±2.31),propofol injection pain(5.65±2.00),shivering(5.67±2.39),intravenous puncture pain(6.02±2.39),and anxiety(6.18±3.27).3.Patients recall of the incidences of common clinical anesthesia outcomes on the first postoperative day were in turn 100%of intravenous puncture pain,99.8%of incisional pain,95.5%of anxiety,57.8%of sore throat,32.6%of nausea,19.4%of vomiting,8.5%of propofol injection pain,7.4%of gagging on the tracheal tube,and 0.2%of shivering.4.The majority(91.5%)of surveyed patients could not recall any discomfort or pain during anesthetics injection on the first postoperative day.Of those who could recall PIP(8.5%),89.5%grade it as mild pain,7.9%moderate pain,and 2.6%severe pain.Recall of PIP did not affect patients' satisfaction scores on anesthesia(P>0.05).Conclusions:1.In general,propofol injection pain is not the main concern for patients.Patients'concerns about avoiding clinical anesthesia outcomes remains mainly on incision pain,nausea,and vomiting.2.The incidence of recall of PIP was low and the majority of those who recalled regarded it as mild,temporary and acceptable pain.And recall of PIP did not affect patients' satisfaction scores on anesthesia.Part Two:Effect of different analgesic methods on anastomotic leakage following esophagectomy:A single-center retrospective studyObjectives:Anastomotic leakage(AL)is one of common complications after esophageal cancer surgery.Thoracic epidural analgesia(TEA)is often recommended in patients undergoing esophagectomy.However,the impact of TEA on AL is still controversial.Thus,we conducted this study to evaluate the effect of TEA on the occurrence of AL and identify risk factors for the development of AL following esophagectomy.Methods:Our retrospective study identified patients who underwent elective esophagectomy between July 2013 and July 2016 at Thoracic Department of Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College.Relative research data of eligible patients were collected,including baseline information,intraoperative parameters and postoperative clinical outcomes.The main postoperative clinical outcome was the occurrence of AL after esophageal cancer surgery.Eligible patients were divided into two groups according to their analgesia methods:intravenous opioid analgesia group(Group IOA,n=1923)and thoracic epidural analgesia group(Group TEA,n=362).Propensity score matching analysis was applied.We compared postoperative clinical outcomes between the two groups before and after propensity score matching.Univariate and multivariate logistics analyses were also conducted to identify the risk factors for AL after esophagectomy.Results:A total of 181 cases of 2285 eligible patients suffered from AL after esophageal cancer surgery(7.9%).There were 1922(84.1%)men and 363(15.9%)women,with a mean age of 61 years in our study.Before propensity matching,1923(84.2%)patients managed postoperative acute pain through IOA while only 362(15.8%)patients through TEA.And some variables were not equally distributed between the two groups.After propensity matching,337 patients in TEA group were matched with 337 patients in IOA group.And the distributions of baseline covariates between the two matched groups were well-balanced.No statistically significant difference was observed in the incidences of AL between the TEA group and IOA group either before or after propensity score matching(9.1%vs.7.7%,P = 0.359;8.3%vs.9.2%,P =0.683).Univariate analysis showed that preoperative chemoradiotherapy,tumor location,tumor histology,surgical method,operation time,total fluids,total crystalloid,total colloid,surgical procedure and surgeon related with AL after esophagectomy.Multivariate analysis revealed that surgical procedure(Sweet:referent;Ivor-Lewis:OR 2.854;95%CI 1.726-4.718;Three-incision:OR 4.837;95%CI 3.457-6.768)and surgeon(High-volume:referent;Low-volume:OR 1.740;95%CI 1.269-2.384)were independent risk factors for AL after esophagectomy.Conclusions:Surgical procedure and low-volume surgeon were independent risk factors for AL;Thoracic epidural analgesia does not affect the AL risk after esophagectomy. |
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