Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Dec 2013
ReviewPain management for the cancer patient - current practice and future developments.
Anaesthesiologists will be asked to provide pain management for cancer patients in the absence of more specialised services, when interventional techniques are indicated and in the postoperative period. In all these settings, the complexity of cancer pain and its psychosocial connotations need to be considered to provide appropriate and holistic care. Principles of systemic pain management, effective in most patients, continue to follow established guidelines; identification of neuropathic pain and its appropriate treatment is important here. ⋯ Postoperative pain management should be multimodal with consideration of regional techniques when applicable. In managing postoperative pain in cancer patients, opioid tolerance needs to be addressed to avoid withdrawal and poor analgesia. Preventive techniques aiming to reduce chronic postoperative pain should be considered.
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Best Pract Res Clin Anaesthesiol · Dec 2013
ReviewUnderstanding clinical strategies that may impact tumour growth and metastatic spread at the time of cancer surgery.
The role of the perioperative period during cancer surgery and its impact on patients' long-term cancer outcomes are of increasing interest. Anticipation and prevention of perioperative immunosuppression and targeted therapeutic interventions that translate to reduced cancer recurrence are increasingly being explored. ⋯ Anaesthesiologists caring for patients with cancer may preferentially employ regional anaesthesia techniques and anti-inflammatory agents to minimise perioperative immunosuppression and preserve perioperative homeostasis. However, prospective trials powered for long-term cancer outcomes are necessary to provide an evidence base before these strategies are to be recommended for routine clinical practice.
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Best Pract Res Clin Anaesthesiol · Dec 2013
ReviewChallenges in research related to perioperative cancer care and cancer outcomes.
Surgery is one of the most commonly used treatments to attempt cure of early-stage and some late-stage solid tumours. Paradoxically, surgery itself and some of the medical interventions involved in the perioperative care of cancer patients may be associated with an increased chance of metastasis. Researchers and perioperative clinicians have studied the phenomenon of surgery-induced immunosuppression and postoperative cancer recurrence for several decades. ⋯ Moreover, a recent proliferation of retrospective studies with conflicting results and significant limitations has not shed light on the understanding of whether regional anaesthesia, anti-inflammatory interventions or blockade of the sympathetic response improve survival after cancer surgery. Ultimately, randomised controlled trials are required to answer some of the questions raised by preclinical and retrospective studies; however, investigators face many challenges in conducting these trials. Unless sufficient funding is obtained and cooperative research is developed in the near future, clinicians will not know whether anticancer perioperative interventions are useful to improve cancer-related survivals.
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Best Pract Res Clin Anaesthesiol · Dec 2013
ReviewIntensive care for the cancer patient - unique clinical and ethical challenges and outcome prediction in the critically ill cancer patient.
With the rising number of cancer cases and increasing survival times, cancer patients with critical illness are increasingly presenting to the intensive care unit. This article considers the unique challenges they pose in terms of oncological-specific disease processes and treatment and reviews current trends in outcome prediction. We also consider the ethical standpoints surrounding the treatment of patients for whom there may be no cure and their subsequent transition to palliative care, should it become necessary.