- Author
-
G. Mazzinari
- Title
- Improving perioperative care
- Supervisors
- Co-supervisors
-
A. Serpa Neto
- Award date
- 11 January 2021
- Number of pages
- 375
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
The concept of perioperative medicine has shifted the focus to what an anesthesiologist can do to improve not only intraoperative management but also the overarching surgical process and its outcome. This thesis is a compilation of investigations concerning the improvement of perioperative care for patients undergoing anesthesia for surgery. Notably we focused our research on four perioperative medicine aspects: pain and airway management, mechanical ventilation, and perioperative clinical outcomes.
We found that performing an interfascial serratus plane block reduces opioid requirements and is associated with a lower need for rescue analgesia in the first 24 hours, in patients undergoing breast surgery. As for airway management, a dynamic guide during videolaryngoscopy improves the chance of first pass intubation in patients with a predicted difficult airway. During intraoperative mechanical ventilation, PEEP can counterbalance the intraabdominal pressure related rise in transpulmonary pressure during laparoscopic surgery and that during abdominal surgery intraoperative driving pressure is associated with occurrence of postoperative pulmonary complications with stronger associations in laparoscopic surgery. Furthermore, we observed that an individualized pneumoperitoneum strategy was associated with faster recovery in laparoscopic colorectal surgery and that postoperative complications occurrence is associated with worse long–term disease free survival. As for anaesthesia associated prognosis markers, μ type I receptor expression was not associated with shorter disease–free nor overall survival.
In conclusion, several aspects of anesthesia-related intraoperative management can improve early and late postoperative outcomes. Great effort should be placed in further enhance anesthesia contribution to better perioperative care. - Persistent Identifier
- https://hdl.handle.net/11245.1/d6f8f71a-ca2a-4bc0-bfd6-0095f1baa0cd
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: General introduction and outline of the thesis
Chapter 2: Interfascial block at the serratus muscle plane versus conventional analgesia in breast surgery: A randomized controlled trial
Chapter 3: Effect of dynamic versus stylet-guided intubation on first-attempt success in difficult airways undergoing glidescope laryngoscopy: A randomized controlled trial
Chapter 4: Intraabdominal pressure targeted positive end-expiratory pressure during laparoscopic surgery: An open-label, nonrandomized, crossover, clinical trial
Chapter 5: Intraoperative driving pressure and occurrence of postoperative pulmonary complications after abdominal surgery: A posthoc propensity score weighted cohort analysis of the LAS VEGAS study comparing open to closed surgery
Chapter 6: An individualized versus a conventional pneumoperitoneum pressure strategy during colorectal laparoscopic surgery: Rationale and study protocol for a multicentre randomised clinical study
Chapter 7: Effect of an individualized versus standard pneumoperitoneum pressure strategy on postoperative recovery: A randomized clinical trial in laparoscopic colorectal surgery
Chapter 8: Impact of postoperative complications on survival and recurrence after resection of colorectal liver metastases: Systematic review and meta-analysis
Chapter 9: Mu opioid receptor 1 (MOR-1) expression in colorectal cancer and oncological long-term outcomes: A five-year retrospective longitudinal cohort study
Chapter 10: Summary
Chapter 11: General discussion
Chapter 12: Nederlandse samenvatting
Authors information; Reference list of published papers and authors’ roles; List of unpublished papers and authors’ roles; Funding and conflict of interest information; PhD portfolio; Curriculum vitae
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