DEPTH OF GENERAL ANESTHESIA AND POSTOPERATIVE MORTALITY

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 最近的几篇论文表明，手术后一年内的死亡率与麻醉深度之间存在关联，麻醉深度是通过麻醉药物对大脑皮层的影响来衡量的。到目前为止，还没有研究令人信服地证明麻醉技术影响围手术期死亡率，如果将其定义为术后30天内死亡。即使是像全身麻醉和神经轴麻醉这样不同的麻醉技术也是如此，在这种技术中，麻醉药物对大脑皮层的影响不是必需的，通常是最小的。临床经验和研究表明，病人对麻醉的抑郁作用更敏感。因此，在手术后一年内观察到的麻醉深度和死亡率之间的任何联系可能与麻醉本身无关，而是与病情较重的患者的生理储备较少有关，并且在麻醉期间，这可能表现为与健康患者相比，患病患者的麻醉深度增加。虽然后者是直观的，但只有前瞻性研究才能最终回答麻醉深度是否与超过1年死亡率有关的问题。我们建议在665名因妇科肿瘤接受下腹部手术的妇女中进行这样的研究。我们将给这些妇女分配三种不同的麻醉方法，并仔细控制麻醉方法、合并情况和其他与早期死亡相关的因素，如冠状动脉缺血、肿瘤分期、应激和认知功能。

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 publications have suggested an association between mortality within a year following surgery and depth of anesthesia, measured as anesthetic drug effect on brain cortex. 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. 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.