title: Effects of combined epidural and general anesthesia on intraoperative hemodynamic responses, postoperative cellular immunity, and prognosis in patients with gallbladder cancer: A randomized controlled trial.
abstract: BACKGROUND
  This study is supposed to investigate the effects of combined epidural and general anesthesia on intraoperative hemodynamic responses, postoperative cellular immunity, and prognosis in patients with gallbladder cancer (GBC).
  
  
  METHODS
  One hundred forty-four GBC patients were selected and randomly divided into the general anesthesia (GA) group and the combined epidural-general anesthesia (CEGA) group. Before anesthesia induction (t0), at intubation (t1), at the beginning of surgery (t2), 5 minutes after pneumoperitoneum (t3), at the end of surgery (t4), after recovery of spontaneous breathing (t5), after regaining consciousness (t6), and after extubation (t7), the heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and the depth of anesthesia (bispectral index [BIS]) were detected. Blood samples were separately collected 30 minutes before anesthesia induction (T1), 2 hours after the beginning of surgery (T2), at the end of surgery (T3), 1 day after surgery (T4), 3 days after surgery (T5). The survival rates of T cell subsets (CD3+, CD4+, CD8+, CD4+/CD8+) and natural killer (NK) cells were determined by flow cytometry. Postoperative nausea and vomiting (PONV), visual analog scale (VAS), and sedation-agitation scale (SAS) were performed to assess postoperative adverse reactions. A 3-year follow-up was conducted.
  
  
  RESULTS
  Compared with the GA group, the CEGA group had significant lower SBP values at t5 and t6, lower DBP values at t1, t3, t4, and t5, lower HR values at t1 and t5, and higher BIS values at t4, t5, t6, and t7. No PONV was observed in the CEGA group. In comparison to the GA group, the VAS was markedly increased and survival rates of CD3+, CD4+, and CD4+/CD8+ cells were increased at T2, T3, T4, and T5 in the CEGA group. The 1-year, 2-year, and 3-year survival rates were not evidently different between the CEGA group and the GA group.
  
  
  CONCLUSIONS
  Our study provides evidence that the combined epidural-general anesthesia might attenuate intraoperative hemodynamic responses and improve postoperative cellular immunity, so that it might be a more available anesthesia method for GBC patients.
authors.affiliation: Department of Anesthesiology, The Xinjiang Uygur Autonomous Region People's Hospital, Urumqi, P.R. China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhu
authors.forename: Xue-Rong
authors.initials: XR
authors.lastname: Zhang
authors.forename: Hu
authors.initials: H
authors.lastname: Yang
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D002470:Cell Survival; D002681:China / Q000453:epidemiology; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D005706:Gallbladder Neoplasms / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D007111:Immunity, Cellular; D007694:Killer Cells, Natural; D008297:Male; D008875:Middle Aged; D016176:T-Lymphocyte Subsets