In Uruguay, after cardiovascular diseases, cancer ranks second as a cause of death. According to official data from the Ministry of Public Health in 2017, 24.6% of deaths were due to this disease. In our specialty, there is great concern about the evolutionary consequences of neoplastic disease related to the surgical anesthetic act, conceptualized from the length of the perioperative period. We consider necessary the inclusion of protocols for neoplastic surgery that favor recovery and evolution in the short and long term. This implies establishing anesthesiological strategies aimed at preserving immunity, by reducing psychological and surgical stress, adequate pharmacological selection, management of the internal environment and analgesia. For these reasons, it is important to establish the implementation of perioperative plans that reduce psychosomatic aggression, which in addition to medical stability, provide quality analgesia, with postoperative well-being that allow rest and recovery. Great advances have been made in tumor resection surgical techniques such as neoadjuvant and adjuvant polychemotherapy techniques, however, tumor recurrence rates have not been reduced as would be desired. Beyond the natural malignancy of the underlying pathology, it is inferred that surgical stress with a long and torpid perioperative period favors tumor recurrence. Hence our special interest in these communications related to patients in the search for solutions that improve their vital prognosis. Based on current evidence, it can be affirmed that the decrease in opiate consumption, especially the decrease in the need for Morphine, may favor better prognoses; maintaining the antimetastatic immune response in a period of special protumoral susceptibility such as the perioperative period. We therefore propose the use of analgesic / anesthetic techniques supported on the basis of regional anesthetic blocks prior to surgical aggression, complemented with the administration of Propofol, NSAIDs and β-blockers during the intraoperative period, through the presentation of 2 clinical cases of patients with osteosarcoma of knee.
Neoplastic pathology is the second cause of death in developed countries. In our specialty, there is great concern about the implications of the anesthetic technique and the drugs used, present in the perioperative period of the cancer patient; as well as other perioperative factors. Among the latter, we highlight the management of psychological stress, adequate pain control, the type of surgery, avoiding hypothermia, and reducing transfusions of blood products. This concern is based on the fact that despite great advances in both surgical techniques for tumor resection and neoadjuvant and adjuvant polychemotherapy techniques; tumor recurrence rates have not decreased as desired. This suggests that the previously mentioned perioperative factors play an active role in tumor recurrence in cancer patients. Based on current evidence and our experience, we can affirm that the use of anesthetic/analgesic techniques based on the use of propofol, NSAIDs, and regional anesthesia with local anesthetics that achieve a decrease in the perioperative consumption of opiates, especially morphine, can be beneficial to protect the anti-metastatic immune response of the organism in a period of special protumoral susceptibility such as the perioperative period.
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