This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Several recent publications1-3 have suggested an association between mortality within a year following surgery and depth of anesthesia, measured as anesthetic drug effect on brain cortex. An accompanying editorial 4 draws attention to the pitfalls of suggesting a cause and effect relationship when observing two phenomena that had not been part of a well reasoned hypothesis. In fact, no study to date has convincingly documented that anesthetic technique impacts perioperative mortality, if it is defined as death within up to 30 days after surgery. This is true even for anesthetic techniques as dissimilar as general anesthesia and neuraxial anesthesia, a technique where anesthetic drug effect on the brain cortex is not required and typically minimal. Clinical experience and studies have shown that sick patients are more sensitive to the depressant effects of anesthesia.5 Therefore, any association observed between depth of anesthesia and mortality within a year following surgery may not be related to the anesthesia per se, but rather to the fact that patients who are more ill have less physiologic reserve, and that during anesthesia, this may be expressed as an increased depth of anesthesia in sick patients as compared to healthy patients. While the latter is intuitive, only a prospective study can ultimately answer the question whether anesthetic depth is related to excess 1-year mortality. We propose to perform such a study in 665 women undergoing lower abdominal surgery for gynecologic tumors. We will assign the women to three different anesthetic techniques and carefully control anesthetic technique, comorbid conditions and other factors associated with early mortality such as coronary ischemia, tumor stage, stress, and cognitive function.
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