Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Review
Can anesthetic-analgesic technique during primary cancer surgery affect recurrence or metastasis?
Mortality among cancer patients is more commonly due to the effects of metastasis and recurrence as opposed to the primary tumour. Various perioperative factors have been implicated in tumour growth, including anesthetic agents and analgesia techniques. In this narrative review, we integrate this information to present a summary of the best available evidence to guide the conduct of anesthesia for primary cancer surgery. ⋯ Current laboratory research suggests that perioperative interventions may impact recurrence or metastasis through effects on cancer cell signalling, the immune response, or modulation of the neuroendocrine stress response. Further evidence is awaited from prospective randomized-controlled trials. Meanwhile, with limited data upon which to make strong recommendations, anesthesiologists should seek optimal anesthesia and analgesia for their patients based on individual risk-benefit analysis and best available evidence on outcomes other than cancer recurrence.
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Perioperative myocardial infarction represents the most common cardiovascular complication following non-cardiac surgery, but frequently presents without the usual clinical signs and symptoms consistent with acute coronary syndrome. Given the silent nature of this event, a clinician's reliance on risk stratification tools and cardiac specific biomarkers to assist in the identification of at-risk individuals is heightened in the perioperative setting. ⋯ This decision is further complicated by the increasing sensitivity of the newest generation of cardiac biomarker immunoassays. In this narrative review, the growing body of evidence surrounding cardiac troponin elevations in the perioperative setting, how the evidence has been integrated into recent clinical practice guidelines, and its implications for the detection of perioperative myocardial infarction are discussed.
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This review discusses the utility of risk scores, specifically, the role of preoperative risk scores in guiding the management of surgical patients, approaches to evaluate the quality of risk scores, and limitations to consider when applying risk scores in clinical practice. ⋯ Preoperative risk scores help inform perioperative clinical decision-making. Future research must determine how estimates of preoperative risk can be updated with information from the intraoperative period, how risk information should be communicated to patients, and which interventions can improve outcomes among patients within newly identified risk strata.
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The purpose of this report is to facilitate an understanding of the possible application of xenon for neuroprotection in critical care settings. This narrative review appraises the literature assessing the efficacy and safety of xenon in preclinical models of acute ongoing neurologic injury. ⋯ According to the evidence to date, the neuroprotective efficacy of xenon in preclinical models and its safety in clinical anesthesia set the stage for the launch of randomized clinical trials to determine whether these encouraging neuroprotective findings can be translated into clinical utility.