[Esophageal cancer surgery: evolution of pain management, hemodynamics and ventilation practices during 16 years]

Abstract

Objective: To describe the evolution of perioperative anesthesia practices in for esophageal cancer surgery.

Patients and methods: We conducted an observational retrospective study in a single center evaluating main perioperative practices during 16 years (1994-2009). Statistical analysis was done on 4 chronologic quartiles of same sample size.

Results: Two hundred and seven consecutive patients were included during the 4 periods 1994-1997 (n=52), 1997-1999 (n=52), 1999-2003 (n=52) and 2004-2009 (n=51). The main significant evolutions between the first and the fourth period were observed: (i) in ventilation: lower tidal volume (9.6[8.6-10.6] vs 7.6[7.0-8.3] mL/kg of ideal body weight (IBW), p<0.01), increased use of Positive End Expiratory Pressure (0 vs 83%, p<0.001) and increased use of post-operative non-invasive ventilation (0 vs 51%, p<0.001); (ii) in hemodynamic management: lower fluid replacement (20.6 [16.0-24.6] vs 12.6 [9.7-16.2] mL/h/kg of IBW, p<0.001); (iii) in analgesia: increased use of epidural thoracic anesthesia (31 vs 57%, p<0.001). Peroperative bleeding, type of fluid replacement, length of mechanical ventilation, length of stay in intensive care unit, ventilatory free days and mortality at day 28 didn't change.

Conclusions: During these previous years, anesthesia practices in ventilation, hemodynamics and analgesia for esophageal cancer surgery have changed.

Keywords: Analgésie péridurale thoracique; Anesthesia practice; Epidural thoracic anesthesia; Esophageal cancer surgery; Non-invasive ventilation; Pratiques anesthésiques; Protective ventilation; Ventilation non invasive; Ventilation protectrice; Œsophagectomie carcinologique.