Lim A, Braat S, Hiller J, Riedel B
Registrar, Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria.
Research Fellow, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria.
Anaesth Intensive Care. 2018 Sep;46(5):480-487. doi: 10.1177/0310057X1804600509.
Increasing evidence suggests that total intravenous anaesthesia (TIVA) may be the preferred anaesthetic for cancer resection surgery. To assist the preparation of a randomised controlled trial (RCT) examining Volatile (versus TIVA) Anaesthesia and Perioperative Outcomes Related to Cancer (VAPOR-C) we developed an 18-question electronic survey to investigate practice patterns and perspectives (emphasising indications, barriers, and impact on cancer outcomes) of TIVA versus inhalational general anaesthesia in Australasia. The survey was emailed to 1,000 (of 5,300 active Fellows) randomly selected Australian and New Zealand College of Anaesthetists (ANZCA) Fellows. The response rate was 27.5% (n=275). Of the respondents, 18% use TIVA for the majority of cases. In contrast, 46% use TIVA 20% of the time or less. Respondents described indications for TIVA as high risk of nausea, neurosurgery, and susceptibility to malignant hyperthermia. Lack of equipment, lack of education and cost were not considered barriers to TIVA use, and a significant proportion (41%) of respondents would use TIVA more often if setup were easier. Of the respondents, 43% thought that TIVA was associated with less cancer recurrence than inhalational anaesthesia, while 46% thought that there was no difference. Yet, only 29% of respondents reported that they use TIVA often or very often for cancer surgery. In Australasia, there is generally a low frequency of TIVA use despite a perception of benefit when compared with inhalational anaesthesia. Anaesthetists are willing to use TIVA for indications where sufficient evidence supports a meaningful level of improvement in clinical outcome. The survey explores attitudes towards use of TIVA for cancer surgery and demonstrates equipoise in anaesthetists' opinions regarding this indication. The inconsistent use of TIVA in Australasia, minimal barriers to its use, and the equipoise in anaesthetists' opinions regarding the effect of TIVA versus inhalational anaesthesia on cancer outcomes support the need for a large prospective RCT.
越来越多的证据表明，全凭静脉麻醉（TIVA）可能是癌症切除手术的首选麻醉方式。为协助准备一项关于挥发性（与TIVA对比）麻醉与癌症相关围手术期结局的随机对照试验（RCT）（VAPOR-C），我们开展了一项包含18个问题的电子调查，以探究澳大利亚和新西兰地区TIVA与吸入性全身麻醉的实践模式及观点（重点关注适应症、障碍以及对癌症结局的影响）。该调查通过电子邮件发送给随机挑选的1000名（共5300名活跃会员）澳大利亚和新西兰麻醉师学院（ANZCA）会员。回复率为27.5%（n = 275）。在受访者中，18%在大多数情况下使用TIVA。相比之下，46%使用TIVA的时间占比为20%或更少。受访者将TIVA的适应症描述为恶心高风险、神经外科手术以及易患恶性高热。缺乏设备、缺乏培训和成本并未被视为TIVA使用的障碍，并且相当比例（41%）的受访者表示如果设备设置更简便，他们会更频繁地使用TIVA。在受访者中，43%认为TIVA与吸入性麻醉相比，癌症复发率更低，而46%认为二者没有差异。然而，只有29%的受访者表示他们在癌症手术中经常或非常频繁地使用TIVA。在澳大利亚和新西兰地区，尽管与吸入性麻醉相比，人们认为TIVA有益，但TIVA的使用频率总体较低。麻醉师愿意在有充分证据支持临床结局有显著改善的适应症中使用TIVA。该调查探讨了对癌症手术使用TIVA的态度，并表明麻醉师对该适应症的意见存在平衡。澳大利亚和新西兰地区TIVA使用的不一致、使用TIVA的障碍极小以及麻醉师对TIVA与吸入性麻醉对癌症结局影响的意见平衡，都支持开展一项大型前瞻性RCT的必要性。
