Perioperative anesthesia care and tumor progression

Sekandarzad, Mir W., van Zundert, André A. J., Lirk, Philipp B., Doornebal, Chris W. and Hollmann, Markus W. (2016) Perioperative anesthesia care and tumor progression. Anesthesia and Analgesia, 124 5: 1697-1708. doi:10.1213/ANE.0000000000001652

Author Sekandarzad, Mir W.
van Zundert, André A. J.
Lirk, Philipp B.
Doornebal, Chris W.
Hollmann, Markus W.
Title Perioperative anesthesia care and tumor progression
Journal name Anesthesia and Analgesia   Check publisher's open access policy
ISSN 1526-7598
Publication date 2016-01-01
Year available 1996
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1213/ANE.0000000000001652
Open Access Status Not yet assessed
Volume 124
Issue 5
Start page 1697
End page 1708
Total pages 12
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Subject 2703 Anesthesiology and Pain Medicine
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.
Keyword Anesthesiology and Pain Medicine
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
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