Anesthesia, surgical stress, and “long-term” outcomes

Abstract

An increasing body of evidence shows that the choice of anesthetic can strongly influence more than simply the quality of anesthesia. Regional and general anesthesia have often been compared to ascertain whether one provides benefits through dampening the stress response or harms by accelerating cancer progression. Regional anesthesia offers considerable advantages, by suppressing cortisol and catecholamine levels and reducing muscle breakdown postoperatively. It also has less immunosuppressive effect and potentially reduces the proinflammatory cytokine response. As such, vital organ functions (e.g., brain and kidney) may be better preserved with regional anesthetics, however, further study is needed. Volatile general anesthetics appear to promote cancer malignancy in comparison to regional and intravenous general anesthetics, and reduce the body's ability to act against cancer cells by suppression of natural killer cell activity. There is not sufficient evidence to support an alteration of current clinical practice, however, further research into this area is warranted due to the potential implications elicited by current studies.

Anestesia loco regional más sedación con dexmedetomidina para cirugía de Mohs con reconstrucción

“…Está ampliamente demostrado que el dolor y ansiedad perioperatorios se asocian a una exacerbación de la respuesta al estrés, con las subsecuentes elevaciones en glicemia, activación del sistema simpático y complicaciones tromboembólicas, isquémicas e inmunológicas (20,21). Por otro lado, una sedación excesiva también puede repercutir negativamente, dada la probabilidad de depresion respiratoria y requerimiento de ventilación mecánica, con la posible necesidad de hospitalización en unidad de cuidado intensivo (16,20,22).…”

“…Por otro lado, una sedación excesiva también puede repercutir negativamente, dada la probabilidad de depresion respiratoria y requerimiento de ventilación mecánica, con la posible necesidad de hospitalización en unidad de cuidado intensivo (16,20,22).…”

Minimizing Stress Response and Cognitive Dysfunction in Orthopedic Surgery: The Prospects of Epidural Anesthesia

“…We can conclude that epidural analgesia positively affects the immune system, preventing severe postoperative immuno suppression, which is particularly due to the increase in the number of CD-3-cells, B-cells, CD4/ CD8 ratio, and partially of NK-cells. In a previous study, higher cortisol levels postoperatively were shown to be associated with a higher chance of developing POCD [4,5,7,8] . Epidural anesthesia has an important influence on the modulation of the immune response in patients who underwent major orthopedic surgery.…”

“…Postoperative cognitive dysfunction (POCD) is a major consequence of this. It is essentially "deterioration in cognition temporally associated with surgery" [4,5] , and might lead to a higher mortality rate within three post-operative months [6] . A number of studies have revealed that the inflammatory response is a key factor in the development of postoperative cognitive dysfunction (POCD) [7][8][9][10] .…”

“…This suggests that although the levels of surgical stress can be associated with POCD, its role as a key factor is still uncertain [18] . The medical and social significance of the issue is due to an increased rate of complications and, therefore, higher delayed mortality, longer duration of hospital stay and rising treatment costs [4] . Currently, the risk factors of POCD have been accurately identified with the aid of evidence-based medicine.…”