Anesthesiology
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Comparative Study
Total Intravenous Anesthesia versus Inhalation Anesthesia for Breast Cancer Surgery: A Retrospective Cohort Study.
Cutting to the chase...
This large, retrospective study with propensity-matched controls found NO difference in breast cancer survival between inhalataional and intravenous anesthetic techniques.
Why is this still important?
Following Exadaktylos' eye-popping 2006 retrospective, along with a few in vitro studies, anesthetists have been a little anxious that anesthetic technique choice could potentially have a such significant effect on cancer recurrence. To date, other trials have not replicated Exadaktylos' original results.
What was studied this time?
Yoo et al performed a retrospective study of 5,331 breast cancer patients over a 8 year period, looking at the relationship between anesthetic technique and both 5-year recurrence-free and overall survival.
There was no difference for either survival metric between inhalational or intravenous anesthesia.
So does this settle it?
Not yet. Although large and high quality, this is still a retrospective study with all the compromises that this brings.
Be smart
While we await results from prospective, randomized trials, we should not be distracted by the magical promise of one technique over another, and instead address the very real impact that anesthesia can have on patient Return to Intended Oncological Therapy (RIOT).
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Randomized Controlled Trial
Norepinephrine Infusion for Preventing Postspinal Anesthesia Hypotension during Cesarean Delivery: A Randomized Dose-finding Trial.
Norepinephrine has been recently introduced for prophylaxis against postspinal hypotension during cesarean delivery; however, no data are available regarding its optimum dose. The objective of this study is to compare three infusion rates of norepinephrine for prophylaxis against postspinal hypotension during cesarean delivery. ⋯ Both the 0.050-μg · kg(-1) · min(-1) and 0.075-μg · kg(-1) · min(-1) norepinephrine infusion rates effectively reduced postspinal hypotension during cesarean delivery compared with the 0.025-μg · kg(-1) · min(-1) infusion rate.
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Comment Letter
Association and Effect of Opioid Abuse-Related Readmission.
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Editorial Comment
Anesthesia and Cancer Recurrence: Context for Divergent Study Outcomes.