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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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.