DEPTH OF GENERAL ANESTHESIA AND POSTOPERATIVE MORTALITY

全身麻醉的深度和术后死亡率

• 批准号: 7374687
• 负责人: CHRISTOPHER SEUBERT
• 金额: $ 3.42万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-12-01 至 2006-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7374687
• 关键词: DEPTH; GENERAL; ANESTHESIA; POSTOPERATIVE; MORTALITY

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Several recent publications1-3 have suggested an association between mortality within a year following surgery and depth of anesthesia, measured as anesthetic drug effect on brain cortex. An accompanying editorial 4 draws attention to the pitfalls of suggesting a cause and effect relationship when observing two phenomena that had not been part of a well reasoned hypothesis. In fact, no study to date has convincingly documented that anesthetic technique impacts perioperative mortality, if it is defined as death within up to 30 days after surgery. This is true even for anesthetic techniques as dissimilar as general anesthesia and neuraxial anesthesia, a technique where anesthetic drug effect on the brain cortex is not required and typically minimal. Clinical experience and studies have shown that sick patients are more sensitive to the depressant effects of anesthesia.5 Therefore, any association observed between depth of anesthesia and mortality within a year following surgery may not be related to the anesthesia per se, but rather to the fact that patients who are more ill have less physiologic reserve, and that during anesthesia, this may be expressed as an increased depth of anesthesia in sick patients as compared to healthy patients. While the latter is intuitive, only a prospective study can ultimately answer the question whether anesthetic depth is related to excess 1-year mortality. We propose to perform such a study in 665 women undergoing lower abdominal surgery for gynecologic tumors. We will assign the women to three different anesthetic techniques and carefully control anesthetic technique, comorbid conditions and other factors associated with early mortality such as coronary ischemia, tumor stage, stress, and cognitive function.

该子项目是利用 NIH/NCRR 资助的中心拨款提供的资源的众多研究子项目之一。子项目和研究者 (PI) 可能已从另一个 NIH 来源获得主要资金，因此可以在其他 CRISP 条目中得到体现。列出的机构是中心的机构，不一定是研究者的机构。最近的几篇出版物 1-3 表明手术后一年内的死亡率与麻醉深度（通过麻醉药物对大脑皮层的作用来衡量）之间存在关联。随附的社论 4 提请注意在观察两种不属于合理假设的现象时提出因果关系的陷阱。事实上，迄今为止还没有研究令人信服地证明麻醉技术会影响围手术期死亡率（如果围手术期死亡率定义为术后 30 天内的死亡）。即使对于全身麻醉和椎管内麻醉等不同的麻醉技术也是如此，这种技术不需要麻醉药物对大脑皮层的影响，而且通常影响很小。 临床经验和研究表明，病人对麻醉的抑制作用更敏感。5因此，观察到的麻醉深度与手术后一年内死亡率之间的任何关联可能与麻醉本身无关，而是与病情较重的患者生理储备较少有关，并且在麻醉期间，这可能表现为与健康患者相比，病人的麻醉深度增加。虽然后者很直观，但只有前瞻性研究才能最终回答麻醉深度是否与超额 1 年死亡率相关的问题。我们建议对 665 名接受下腹部妇科肿瘤手术的女性进行这样的研究。我们将为这些女性分配三种不同的麻醉技术，并仔细控制麻醉技术、合并症以及与早期死亡相关的其他因素，如冠状动脉缺血、肿瘤分期、压力和认知功能。