Clinical study of the effects of epidural combined with general anesthesia on the perioperative pulmonary function in patients treated with cytoreductive surgery combineds with hyperthermic intraperitoneal chemotherapy

Objective To investigate the effects of epidural combined with general anesthesia on the perioperative pulmonary function in patients treated with cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods A total of 120 patients who underwent CRS combined with HIPEC in Beijing Shijitan Hospital from January 2018 to March 2019 were selected, and divided into the observation group (epidural combined with total intravenous anesthesia) and control group (total intravenous anesthesia) according to the random number table method, with 60 cases in each group. The peak airway pressure (Ppeak), plateau airway pressure (Pplat) and mean airway pressure (Pmean) during mechanical ventilation were recorded at 5 minutes after tracheal intubation (T₀), 1 hour after the start of surgery (T₁), before the start of HIPEC (T₂), at the end of HIPEC (T₃) and at the end of the surgery (T₄). The dynamic lung compliance (Cdyn) was calculated. Radial artery blood was collected at each time point for blood gas analysis. The arterial partial pressure of oxygen (PaO₂) was recorded, and the oxygenation index (OI), respiratory index (RI), alveolar-arterial partial pressure difference of oxygen (A-aDO₂) and dead cavity rate (V_D/V_T) were calculated. The occurrence of pulmonary complications within 7 days after the operation were recorded.

Results The PaO₂ and Cdyn at T₃ and T₄ in the observation group were higher than those in the control group, while the Ppeak, Pplat and Pmean were lower than those in the control group (P ＜ 0.01). The OI, RI and A-aDO₂ at T₃ and T₄ in the observation group were all better than those in the control group (P ＜ 0.05 to P ＜ 0.01), and there was no statistical significance in the V_D/V_T between two groups at each time point (P ＞ 0.05). The total incidence of pulmonary complications within 7 days after surgery in the observation group was 15.00%, which was lower than 35.00% in the control group (P ＜ 0.05).

Conclusions Epidural combined with general anesthesia can improve perioperative respiratory mechanics and pulmonary function in patients with CRS combined with HIPEC, and reduce the incidence of pulmonary complications