Anaesthesia
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Immunotherapy has transformed cancer treatment, particularly with immune checkpoint inhibitors and chimeric antigen receptor T-cell therapy. Despite their efficacy, these therapies can induce cardiotoxicity, presenting significant clinical challenges. Immune checkpoint inhibitors can cause myocarditis; pericarditis; arrhythmias; and myocardial infarction through immune-mediated inflammation. Chimeric antigen receptor T-cell therapy may result in cardiovascular complications due to cytokine release syndrome, including myocardial dysfunction, endothelial damage and arrhythmias. ⋯ As the use of immunotherapy expands, understanding the mechanisms, risk factors and management strategies for cardiotoxicity is increasingly important. Collaborative efforts among oncologists, cardiologists and anaesthetists are essential to mitigate these risks, especially in peri-operative settings. Ongoing research is vital to improve the safe and effective use of immunotherapeutic drugs while minimising cardiovascular adverse effects.
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Review
The increasing global burden of cancer: implications for anaesthesia and peri-operative medicine.
Most patients with cancer will require surgery at some point in their lifetime. As the global burden of cancer continues to increase, changes and challenges in cancer epidemiology and care are also borne peri-operatively. ⋯ Deeper engagement of anaesthetists in cancer care programmes will be instrumental in reducing postoperative complications; improving the quality of life for patients; enhancing population health; and contributing to improved global economies.
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The peri-operative period may create a biological environment conducive to cancer cell survival and dissemination. Microscopic residual tumours (micrometastases) can be dislodged even with excellent surgical technique. At the same time, the stress response from surgery can temporarily impair immune function and activate inflammatory processes, increasing the risk of tumour proliferation. ⋯ There is a complex interplay between anaesthetic and analgesic techniques and cancer outcomes. Despite promising data from laboratory experimental models, the balance of available clinical trials indicates an equivalent influence of all evaluated anaesthetic techniques on long-term oncologic outcomes, except, possibly, for peritumoral or intraperitoneal local anaesthetic infiltration.
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Oncoanaesthesia is a specialised branch of anaesthesia dedicated to enhancing outcomes, prioritising patient safety and improving the overall care of patients with cancer during surgery. We outline the global epidemiology of cancer, emphasising the necessity for this subspecialty, and discuss the criteria supporting its establishment. ⋯ By integrating various subspecialties within oncology centres, oncoanaesthesia ensures a thorough and holistic approach to both curative and palliative cancer care, ultimately improving patient outcomes and providing better support for families and caregivers throughout the peri-operative period.
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Cancer research has revolutionised the treatment, quality of life and life expectancy of people living with cancer. Systemic anti-cancer treatments have expanded to involve not only cytotoxic drugs, but targeted drugs and immunotherapy. Although highly effective in many patients, these drugs can cause serious and sometimes life-threatening adverse reactions. As part of their treatment, many patients living with cancer will be offered both systemic anti-cancer therapy and surgery, and many patients will undergo recurrent episodes of both with the aims of cure, palliation or prolongation of life expectancy. It is important for anaesthetists to understand the effects of systemic anti-cancer therapy on their patients. ⋯ It is important for anaesthetists to have a comprehensive understanding of the effects of systemic anti-cancer therapies, including cytotoxic and immunotherapies. There are many potential toxicities and complications associated with these treatments, particularly in the context of emergency surgery and the administration of cytotoxic drugs within the operating theatre environment.