Effect of different anesthesia techniques on intraoperative stress-induced immunosuppression in patients undergoing radical esophagectomy'

Patients undergoing radical esophagectomy were randomly assigned to one of the two groups. In group I (n=20), patients received total intravenous general anesthesia (Group TIVA); in group II (n=20), patients received total intravenous general anesthesia combined with thoracic epidural anesthesia (Group TIVA+TEA). Each test solution was prepared in a syringe by the first investigator, who was also responsible for subject grouping. Under sterile conditions, a thoracic epidural catheter was placed via the T7–8 interspace and was advanced 3–4 cm cephalad by the first investigator. A test dose of 1% lidocaine 5 mL, alone, was then given by the first investigator via the thoracic epidural catheter, followed by 0.375% ropivacaine 5 mL, to produce a bilateral segmental sensory block to pinprick between the T6 and L4 dermatomes, or given 10mL normal saline. Then neuraxial block was maintained with 0.375% ropivacaine 5 mL/h or normal saline 5 mL/h throughout the surgical procedure by the second anaesthesiologist. Entropy index was used to maintain the depth of anesthesia to a certain level. Plasma levels of stress hormones and cytokines were assessed before surgery and as well as 1 and 3 hours after the beginning of surgery.