Journal ArticleDOI
Perioperative Anesthesia Care and Tumor Progression.
TLDR
In this paper, the authors discuss the most recent up-to-date findings focused on the currently available "best clinical practice" regarding perioperative anesthesia care bundle factors and their effect on tumor progression.Abstract:
This narrative review discusses the most recent up-to-date findings focused on the currently available "best clinical practice" regarding perioperative anesthesia care bundle factors and their effect on tumor progression. The main objective is to critically appraise the current literature on local anesthetics, regional outcome studies, opioids, and nonsteroidal anti-inflammatory drugs (NSAIDs) and their ability to decrease recurrence in patients undergoing cancer surgery. A brief discussion of additional topical perioperative factors relevant to the anesthesiologist including volatile and intravenous anesthetics, perioperative stress and anxiety, nutrition, and immune stimulation is included. The results of several recently published systematic reviews looking at the association between cancer recurrences and regional anesthesia have yielded inconclusive data and provide insufficient evidence regarding a definitive benefit of regional anesthesia. Basic science data suggests an anti tumor effect induced by local anesthetics. New refined animal models show that opioids can safely be used for perioperative pain management. Preliminary evidence suggests that NSAIDs should be an essential part of multimodal analgesia. Volatile anesthetics have been shown to increase tumor formation, whereas preclinical and emerging clinical data from propofol indicate tumor protective qualities. The perioperative period in the cancer patient represents a unique environment where surgically mediated stress response leads to immune suppression. Regional anesthesia techniques when indicated in combination with multimodal analgesia that include NSAIDs, opioids, and local anesthetics to prevent the pathophysiologic effects of pain and neuroendocrine stress response should be viewed as an essential part of balanced anesthesia.read more
Citations
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Journal ArticleDOI
Analgesic efficacy of the Pecs II block: a systematic review and meta-analysis.
TL;DR: The Pecs II block offers improved analgesic efficacy compared with systemic analgesia alone and comparable opioid efficacy to a thoracic paravertebral block for breast cancer surgery.
Journal ArticleDOI
Efficacy of erector spinae plane block for analgesia in breast surgery: a systematic review and meta-analysis.
TL;DR: It is shown that the erector spinae plane block is more effective at reducing postoperative opioid consumption and pain scores up to 24 hours compared with general anaesthesia alone and its analgesic efficacy was inferior to pectoralis nerve block and similar to paravertebral block.
Journal ArticleDOI
Implicating anaesthesia and the perioperative period in cancer recurrence and metastasis
Julia Dubowitz,Julia Dubowitz,Erica K. Sloan,Erica K. Sloan,Erica K. Sloan,Bernhard Riedel,Bernhard Riedel,Bernhard Riedel +7 more
TL;DR: An up-to-date review of current clinical evidence supporting or refuting the role of perioperative stress, anaesthetic techniques and anaesthetic agents in cancer progression and pre-clinical studies that provide insights into biological mechanisms are provided.
Journal ArticleDOI
The Amide Local Anesthetic Lidocaine in Cancer Surgery-Potential Antimetastatic Effects and Preservation of Immune Cell Function? A Narrative Review.
TL;DR: Intravenous lidocaine as part of the perioperative anesthesia regimen would be of major interest for clinicians, as it might bear the potential to reduce the risk of cancer recurrence or progression patients undergoing cancer surgery.
Journal ArticleDOI
Regional anaesthesia and outcomes.
TL;DR: In this paper, the contribution of the individual anaesthetist in managing the RA (or GA) technique effectively and safely in order to achieve a good outcome must not be underestimated.
References
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Journal ArticleDOI
Cancer Immunoediting: Integrating Immunity’s Roles in Cancer Suppression and Promotion
TL;DR: A unifying conceptual framework called “cancer immunoediting,” which integrates the immune system’s dual host-protective and tumor-promoting roles is discussed.
Journal ArticleDOI
Thrombus aspiration during ST-segment elevation myocardial infarction.
Ole Fröbert,Bo Lagerqvist,Göran K. Olivecrona,Elmir Omerovic,Thorarinn Gudnason,Michael Maeng,Mikael Aasa,Oskar Angerås,Fredrik Calais,Mikael Danielewicz,David Erlinge,Lars Hellsten,Ulf Jensen,Agneta C. Johansson,Amra Kåregren,Johan Nilsson,Lotta Robertson,Lennart Sandhall,Iwar Sjögren,Ollie Östlund,Jan Harnek,Stefan James +21 more
TL;DR: Routine thrombus aspiration before PCI as compared with PCI alone did not reduce 30-day mortality among patients with STEMI, and results were consistent across all major prespecified subgroups, including subgroups defined according toThrombus burden and coronary flow before PCI.
Journal ArticleDOI
Can Anesthetic Technique for Primary Breast Cancer Surgery Affect Recurrence or Metastasis
Aristomenis K. Exadaktylos,Donal J. Buggy,Denis C. Moriarty,Edward J. Mascha,Daniel I. Sessler +4 more
TL;DR: A retrospective analysis suggests that paravertebral anesthesia and analgesia for breast cancer surgery reduces the risk of recurrence or metastasis during the initial years of follow-up.
Journal ArticleDOI
Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis
Barbara Biki,Edward J. Mascha,Denis C. Moriarty,John M. Fitzpatrick,Daniel I. Sessler,Donal J. Buggy +5 more
TL;DR: Open prostatectomy surgery with general anesthesia, substituting epidural analgesia for postoperative opioids, was associated with substantially less risk of biochemical cancer recurrence.
Journal ArticleDOI
The Randomized Registry Trial — The Next Disruptive Technology in Clinical Research?
TL;DR: The registry-based randomized trial may make less expensive, more efficient clinical studies possible, but before the new study design can be widely used, questions about the quality of the underlying data sets must be addressed.