Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The purpose of this narrative review is to address perioperative bleeding and transfusion as determinants of adverse outcomes after cardiac surgery. ⋯ Perioperative bleeding itself is a complex syndrome that can be classified as an outcome measure. Red blood cell transfusion has limitations when considered as an outcome variable and can be biased by many confounders. Its relationship with clinical outcome remains uncertain. In addition to being potential outcome measures, transfusion rates and the number of allogeneic blood products transfused may also be considered as quality-of-care markers.
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The goal of this narrative review is to consider and categorize the clinically relevant outcomes that have been previously investigated in neuroanesthesia and to propose the essential outcomes and directions that deserve priority in clinical care and future outcome-oriented research. ⋯ Future endeavours in neuroanesthesia research should advocate prospective randomized trials that focus on long-term neurologic outcomes. These initiatives will require coordination of multiple centres through a clinical trials network.
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The purpose of this paper is to review the current evidence relating anesthetic depth to long-term survival after surgery. ⋯ The available evidence on anesthetic depth and long-term survival is inconclusive. Randomized controlled trials with carefully controlled arterial blood pressure are required.
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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.