Articles: anesthesia.
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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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Journal of anesthesia · Feb 2025
ReviewNew insights in cardiovascular anesthesia: a dual focus on clinical practice and research.
Accumulation of the results of basic and clinical research has advanced the safety and quality of management in cardiovascular anesthesia. To address recent developments in this field, a symposium was held during the 71th Japanese Society of Anesthesiologists annual meetings in 2024, focusing on new advancements in both clinical and basic research in cardiovascular anesthesia. ⋯ Each expert summarized recent novel findings, clinical reliability and concerns, as well as future directions in their respective topics. We believe that this special article provides valuable insights into both clinical practice and basic research in cardiovascular anesthesia while also inspiring anesthesiologists to pursue further research in this field.
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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.
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Review Meta Analysis Comparative Study
Postoperative delirium under general anaesthesia by remimazolam versus propofol: A systematic review and meta-analysis of randomised controlled trials.
Remimazolam, an ultra-short-acting benzodiazepine, has similar clinical effects to propofol for sedation in general anaesthesia. However, it remains uncertain whether remimazolam could increase postoperative delirium (POD) compared with propofol. ⋯ Perioperative remimazolam administration did not increase POD and reduced the risk of intraoperative hypotension compared to propofol. Further large-scale RCTs are warranted to explore the association of remimazolam and POD. Systematic review protocol: PROSPERO CRD42024544122.
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Editorial Review
New device, old algorithm? Bridging generations in perioperative coagulation management.
Viscoelastic testing permits targeted correction of coagulopathy in bleeding patients. As new generations of viscoelastic testing platforms become available, research exploring similarities and differences with older devices can provide insight for institutions seeking to use the newer technologies. Care must be taken to ensure such studies are designed to produce clinically meaningful guidance for adapting existing treatment algorithms to accommodate the latest viscoelastic testing technology.