[Esophageal cancer surgery: evolution of pain management, hemodynamics and ventilation practices during 16 years].
OBJECTIVE
To describe the evolution of perioperative anesthesia practices in for esophageal cancer surgery.


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.
Département d'anesthésie-réanimation St-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Inserm U1046, université Montpellier 1, Montpellier, France.
Y
Y
Coisel
Département d'anesthésie-réanimation St-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
A
A
Jourdan
Département d'anesthésie-réanimation St-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
M
M
Conseil
Département d'anesthésie-réanimation St-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
Y
Y
Pouzeratte
Département d'anesthésie-réanimation St-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
D
D
Verzilli
Département d'anesthésie-réanimation St-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Inserm U1046, université Montpellier 1, Montpellier, France.
B
B
Jung
Département d'anesthésie-réanimation St-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Inserm U1046, université Montpellier 1, Montpellier, France.
G
G
Chanques
Département d'anesthésie-réanimation St-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Inserm U1046, université Montpellier 1, Montpellier, France. Electronic address: s-jaber@chu-montpellier.fr.
S
S
Jaber
D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods; D001810:Blood Volume / Q000502:physiology; D004938:Esophageal Neoplasms / Q000601:surgery*; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D059408:Pain Management / Q000639:trends*; D010149:Postoperative Pain / Q000188:drug therapy*; D011175:Positive-Pressure Respiration; D012121:Respiration, Artificial / Q000639:trends*; D012189:Retrospective Studies; D013990:Tidal Volume / Q000502:physiology
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