Long Term Consequences. Anesthetic Choice/Management. Goals. Perioperative management implications for cancer patients. PeriOperative Morbidity & Mortality. 1980’s Anesth mortality was 1:10,000 now this is closer to 1:100,000 Δ Mandated SpO2, ETCO2, NIBP,ECG and AAM technology
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Perioperative management implications for cancer patients
Opiod Receptor Gene A118G polymorphism predicts survival in patients with breast cancerBortstov AV et al Anesthesiology April 2012 896-902
Note: narcotic doses required to generate a stress free surgical anesthetic are impractical in most instances.
Caveat: adequate perfusion pressure
Long term survival after colon cancer surgery:A variation associated with the choice of anesthesiaChristopherson R et al AnesthAnalg 2008:107;325-32
Epidural vs Traditional Pain Mgmt – Survival & Ca recurrance after Colectomy . Cummings KC etalAnesthesiology April 2012: 797- 805
Anesthetic Technique for Radical Prostatectomy Surgery Affects Cancer Recurrance – Retrospective Analysis Biki B et al Anesthesiology 2008: 109; 180-7
Anesthetic Technique for Radical Prostatectomy Surgery Affects Cancer Recurrance – Retrospective Analysis Biki B et al Anesthesiology 2008: 109; 180-7 ......cont
PSA from post op nadir possible Rad Rx, endocrine or chemo Rx
Potential Influence of the Anesthetic Technique used during Open Radical Prostatectomy on Prostate Cancer related Outcome Wuethrich PY et al Anesth 2010:113;570-6
Do Intraoperative Analgesics Influence Breast Cancer Recurrence after Mastectomy? A retrospective analysisAnesthAnalg 2010: 110; 1630-5
Epidural anesthesia for this procedure can be associated with referred pain requiring add’nopiods. This could also limit current intensity or duration of therapy. Epi patients did not have any opiod sparing in the post op period.
What do we know about surgical stress response and Cancer?
The answer is : IT DEPENDENDS
Volatile Anesthetics Reduce Invasion of Colorectal Cancer cells thru down regulation of matrix metalloproteinase -9Muller Edenborn et al Anesthesiology 2012 117: 293-301
Data suggests;the possibility that anesthetic conduct may contribute to the recurrence of cancer ( liberal opiod Rx or inadequate analgesia)
Equally worrying is the possibility that anesthesia, or the stress response to surgery could activate dormant cancer cells in an individual undergoing non cancer surgery.