Long-term Consequences of Anesthetic Management

Anesthesiology (Impact Factor: 5.88). 08/2009; 111(1):1-4. DOI: 10.1097/ALN.0b013e3181a913e1
Source: PubMed


Long-term consequences of anaesthesia were not seriously considered until relatively recently. But there is increasing evidence that some intraoperative anaesthetic management decisions do have long-term consequences, and that others might as well. Thus, that infection risk is diminished by factors such as tissue oxygenation, adequate sympathetic block, and good control of surgical pain. An additional long-term outcome to consider is cancer. Regional anesthesia prevents the neuroendocrine stress response to surgery, reduces release of endogenous opioids and consequently, preserves NK-cell function. Furthermore, regional analgesia avoids the need for postoperative opioids, and the consequent adverse effects on immune function and of tumor growth. It reduces the metastatic burden in animal models. Paravertebral block for breast cancer surgery and epidural block for prostatic cancer surgery are associated with a reduced risk of recurrence or metastasis. Other long-term outcomes that have been and are still studied, include dangers associated with red cell transfusions, the risks and benefits of tight glycemic control, consequences of perioperative fluid management, postoperative cognitive dysfunction, anesthetic toxicity in newborns, and beta-blocker use.

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Available from: Daniel Sessler, Dec 19, 2013
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    • "The possibility that anesthetic management influences long-term outcomes in surgical patients is intriguing, but remains largely speculative. Nonetheless, there is limited (and often controversial) evidence – or at least plausible mechanisms – to suggest that anesthetic management might influence diverse outcomes including wound infection [30-32], major cardiac complications and strokes [33], brain development [34], cancer recurrence [35-37], and mortality [30,38]. Because the inflammatory response to surgery seems likely to be an important potential mechanism, and possibly even a common pathway for many outcomes, we evaluated the cytokine responses in patients randomly assigned to TIVA or volatile anesthesia. "
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    ABSTRACT: Background Whether inflammatory responses to surgery are comparably activated during total intravenous anesthesia (TIVA) and during volatile anesthesia remains unclear. We thus compared the perioperative effects of TIVA and isoflurane anesthesia on plasma concentrations of proinflammatory and anti-inflammatory interleukins and cell adhesion molecules. Methods Patients having laparoscopic cholecystectomies were randomly allocated to two groups: 44 were assigned to TIVA and 44 to isoflurane anesthesia. IL-1β, IL-6, IL-8, IL-10, IL-13, and the cellular adhesion molecules intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 were determined preoperatively, before incision, and at 2 and 24 hours postoperatively. Our primary outcomes were area-under-the-curve cytokine and adhesion molecule concentrations over 24 postoperative hours. Results The only statistically significant difference in area-under-the-curve concentrations was for IL-6, which was greater in patients given isoflurane:78 (95% confidence interval (CI): 52 to 109) pg/ml versus 33 (22 to 50) pg/ml, P= 0.006. Two hours after surgery, IL-6 was significantly greater than baseline in patients assigned to isoflurane: 47 (95% CI: 4 to 216, P<0.001) pg/ml versus 18 (95%CI: 4 to 374, P<0.001) pg/ml in the TIVA group. In contrast, IL-10 was significantly greater in patients assigned to TIVA: 20 (95% CI: 2 to 140, P<0.001) pg/ml versus 12 (95% CI: 3 to 126, P<0.001) pg/ml. By 24 hours after surgery, concentrations were generally similar between study groups and similar to baseline values. Conclusion The only biomarker whose postoperative area-under-the-curve concentrations differed significantly as a function of anesthetic management was IL-6. Two hours after surgery, IL-6 concentrations were significantly greater in patients given isoflurane than TIVA. However, the differences were modest and seem unlikely to prove clinically important. Further studies are needed.
    05/2013; 2(1). DOI:10.1186/2047-0525-2-8
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    • "Immune response is subject to neuroendocrine regulation and elicits neuroendocrine changes [17], augmenting or blunting the neuroendocrine response. It therefore affects postoperative immune function, and ultimately long-term outcomes [18, 19]. "
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    ABSTRACT: Neuraxial anesthesia is a term that denotes all forms of central blocks, involving the spinal, epidural, and caudal spaces. Epidural anesthesia is a versatile technique widely used in anesthetic practice. Its potential to decrease postoperative morbidity and mortality has been demonstrated by numerous studies. To maximize its perioperative benefits while minimizing potential adverse outcomes, the knowledge of factors affecting successful block placement is essential. This paper will provide an overview of the pertinent anatomical, pharmacological, immunological, and technical aspects of epidural anesthesia in both adult and pediatric populations and will discuss the recent advances, the related rare but potentially devastating complications, and the current recommendations for the use of anticoagulants in the setting of neuraxial block placement.
    Anesthesiology Research and Practice 01/2012; 2012(5):309219. DOI:10.1155/2012/309219
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