Kim Daniel D, DeSnyder Sarah M, Dougherty Patrick M, Cata Juan P
Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA.
BJA Open. 2022 Dec 31;5:100119. doi: 10.1016/j.bjao.2022.100119. eCollection 2023 Mar.
Clinical evidence suggests that chemotherapeutic agents are associated with neuropathy and peripheral autonomic dysfunction. However, the possible effects of neoadjuvant chemotherapy on intraoperative temperature remain poorly characterised.
We evaluated patients who underwent a mastectomy for breast cancer between April 2016 and July 2020. Propensity scores were used to match patients who received neoadjuvant chemotherapy with those who did not, and intraoperative core temperature patterns were analysed in the matched cohort. The independent associations between vasopressor use and heart rate during general anaesthesia in the matched cohort were also analysed.
Data from 1764 patients were analysed (882 patients in each group). Both groups presented a similar pattern of heat redistribution and subsequent rewarming; however, the neoadjuvant chemotherapy group did not reach the same intraoperative plateau temperature as the group that did not receive prior chemotherapy, with differences of up to 0.4°C (95% confidence interval: 0.11-0.63°C; =0.005). In a subgroup analysis, neuropathy in patients who received neoadjuvant chemotherapy was associated with increased use of vasopressors and higher heart rate.
In patients with breast cancer, neoadjuvant chemotherapy is associated with lower plateau core temperatures, increased vasopressor use, and higher heart rates during general anaesthesia, which is more severe in the presence of neuropathy.
临床证据表明，化疗药物与神经病变和外周自主神经功能障碍有关。然而，新辅助化疗对术中体温的可能影响仍未得到充分描述。
我们评估了2016年4月至2020年7月期间接受乳腺癌乳房切除术的患者。使用倾向评分将接受新辅助化疗的患者与未接受新辅助化疗的患者进行匹配，并在匹配队列中分析术中核心体温模式。还分析了匹配队列中全身麻醉期间血管升压药使用与心率之间的独立关联。
分析了1764例患者的数据（每组882例患者）。两组呈现出相似的热量再分布和随后复温模式；然而，新辅助化疗组未达到未接受先前化疗组相同的术中平台体温，差异高达0.4°C（95%置信区间：0.11 - 0.63°C；P = 0.005）。在亚组分析中，接受新辅助化疗患者的神经病变与血管升压药使用增加和心率升高有关。
在乳腺癌患者中，新辅助化疗与较低的平台核心体温、血管升压药使用增加以及全身麻醉期间较高的心率有关，在存在神经病变时更为严重。
