We hypothesize that an immune protective anesthesia strategy for cancer patients preserves immune response during endoscopic colon surgery
ID
Bron
Verkorte titel
Aandoening
Colon Cancer, Anesthesiology, Immune response
Ondersteuning
Onderzoeksproduct en/of interventie
Uitkomstmaten
Primaire uitkomstmaten
The main study parameter is the immunological response between conventional anesthesia and immune protective anesthesia after 24 hours.
Achtergrond van het onderzoek
Surgical resection for cancer is still the mainstay of treatment. Although multimodal treatment of cancer patients has improved dramatically, there is increasing evidence that the method of anesthesia might improve cancer free survival. Anesthesia is known to influence the immune response, mostly in a negative way by depressing natural killer (NK) cell activity and T-cell lymphocytes. However, during surgical resection of a solid tumor, a well functioning immune response is pivotal to eliminate micro-metastases. Anesthesia during cancer surgery should be focused on immune protection without compromising patient’s safety or comfort in the perioperative phase. We hypothesize that an immune protective anesthesia strategy for cancer patients preserves immune response during endoscopic colon surgery.
Doel van het onderzoek
We hypothesize that an immune protective anesthesia strategy for cancer patients preserves immune response during endoscopic colon surgery
Onderzoeksopzet
Bloodsamples are taken on:
T0=prior to study
T1=24hrs after surgery
T2=48hrs after surgery
Onderzoeksproduct en/of interventie
1. Conventional anesthesia:
- Preoperative Paracetamol
- Intravenous analgesia with opioids and postoperative pain management with Dipidolor or morphine according to local protocols.
- Anesthesia only with Sevoflurane; dosage according to the bispectral index scale (BIS) with target values between 40 and 60.
- Ketamine, Clonidine and Dexamethason according to the judgment of the anesthesiologist.
- No Dexmedetomidine, epidurale analgesia, continueous lidocaine or COX-2 inhibitor.
2. Immune protective regime:
- Single dose of preoperative Paracetamol and Midazolam (dosage according to anesthesiologist)
- Analgesia perioperative: epidural (only with local anesthetic), Paracetamol, Dexmedetomidine (between 0.2 and 1.0 ug/kg/hr without any bolus) starting before epidural
- Analgesia postoperative: epidurale analgesia according to local protocols (only with local anesthetic) and Paracetamol
- Anesthesia only with Propofol; dosage according to the bispectral index scale (BIS) with target values between 40 and 60.
- Without peri- or postoperative use of opiates, Ketamine, Clonidine or Dexamethason
- Hypotension should preferably be treated with phenylephrine
Publiek
Wetenschappelijk
Belangrijkste voorwaarden om deel te mogen nemen (Inclusiecriteria)
- All patients approved by the anesthesiologist for elective endoscopic colon surgery for cancer.
- > 18 year with written informed consent
Belangrijkste redenen om niet deel te kunnen nemen (Exclusiecriteria)
- neoadjuvant chemo and/or radiotherapy
- Perioperatieve conversion to an open surgical approach
- Insufficient pain relief in the intervention group (Visual Analogue Scale (VAS) ≥ 4)
- Absolute contra-indications for the use of a any of the listed medications or procedures (epidural) in the intervention group
- Synchronous metastasis (stage IV/ M1 patients)
- Patients who are mentally disabled or incapable to give informed consent
- Patients on chronic opioid therapy
Opzet
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In overige registers
| Register | ID |
|---|---|
| NTR-new | NL7216 |
| NTR-old | NTR7415 |
| CCMO | NL58206.056.17 |
| OMON | NL-OMON46294 |