Paravertebral block can attenuate cytokine response when it replaces general anesthesia for cancer breast surgeries

Sultan, Sherif S

doi:10.4103/1658-354x.121043

Cited by 23 publications

(29 citation statements)

References 34 publications

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“…Overall, the studies found a small to modest reduction in inflammatory biomarkers (ie, interleukin 1 [IL-1], IL-6, MMP-3, and MMP-9) and markers of the stress response (ie, serum cortisol, serum glucose, and C-reactive protein) in patients who received a PVB. 19,21,22 The same studies could not demonstrate any significant difference in the concentrations of circulating anti-inflammatory such as IL-10. 21,22 The impact of PVB on the serum concentrations of cytokines with predominant antitumor effects such as interferon, IL-2, and IL-12 was less clear.…”

Section: Discussionmentioning

confidence: 78%

“…19,21,22 The same studies could not demonstrate any significant difference in the concentrations of circulating anti-inflammatory such as IL-10. 21,22 The impact of PVB on the serum concentrations of cytokines with predominant antitumor effects such as interferon, IL-2, and IL-12 was less clear. Whereas Sultan 22 found that women with a PVB had higher circulating concentrations of interferon than did those without a block, Deegan et al 21 observed no change in the concentrations of that cytokine.…”

Section: Discussionmentioning

confidence: 78%

“…Whereas Sultan 22 found that women with a PVB had higher circulating concentrations of interferon than did those without a block, Deegan et al 21 observed no change in the concentrations of that cytokine. 21,22 A second mechanism by which regional anesthesia may improve the survival of patients after breast cancer surgery is through a reduction in the concentrations of growth factors with proliferative or angiogenesis effects. Two RCTs compared the postoperative concentrations of vascular endothelial growth factor (VEGF) in women who received PVB/propofol GA and those treated with sevoflurane/opioid GA.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of Regional Anesthesia on Recurrence, Metastasis, and Immune Response in Breast Cancer Surgery

Pérez-González

Cuéllar-Guzmán

Soliz

et al. 2017

Regional Anesthesia and Pain Medicine

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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Impact of Regional Anesthesia on Recurrence, Metastasis, and Immune Response in Breast Cancer Surgery

Pérez-González

Cuéllar-Guzmán

Soliz

et al. 2017

Regional Anesthesia and Pain Medicine

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“…It became clear that IFN, TNF-␣, members of the interleukin (IL) family, and other cytokine mediators are highly sensitive to experimental conditions that are related to critical illness. A partial listing with representative references includes sepsis (241,328), mechanical trauma (246), surgery (670,802), pneumonia (71,527), drug-induced organ failure (660), thermal injury (484,743), and peritonitis (36).…”

Section: A Cytokine Elevation In Critical Illnessmentioning

confidence: 99%

The Sick and the Weak: Neuropathies/Myopathies in the Critically Ill

Friedrich

Reid

Berghe

et al. 2015

Physiological Reviews

279

329

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Critical illness polyneuropathies (CIP) and myopathies (CIM) are common complications of critical illness. Several weakness syndromes are summarized under the term intensive care unit-acquired weakness (ICUAW). We propose a classification of different ICUAW forms (CIM, CIP, sepsis-induced, steroid-denervation myopathy) and pathophysiological mechanisms from clinical and animal model data. Triggers include sepsis, mechanical ventilation, muscle unloading, steroid treatment, or denervation. Some ICUAW forms require stringent diagnostic features; CIM is marked by membrane hypoexcitability, severe atrophy, preferential myosin loss, ultrastructural alterations, and inadequate autophagy activation while myopathies in pure sepsis do not reproduce marked myosin loss. Reduced membrane excitability results from depolarization and ion channel dysfunction. Mitochondrial dysfunction contributes to energy-dependent processes. Ubiquitin proteasome and calpain activation trigger muscle proteolysis and atrophy while protein synthesis is impaired. Myosin loss is more pronounced than actin loss in CIM. Protein quality control is altered by inadequate autophagy. Ca 2ϩ dysregulation is present through altered Ca 2ϩ homeostasis. We highlight clinical hallmarks, trigger factors, and potential mechanisms from human studies and animal models that allow separation of risk factors that may trigger distinct mechanisms contributing to weakness. During critical illness, altered inflammatory (cytokines) and metabolic pathways deteriorate muscle function. ICUAW prevention/treatment is limited, e.g., tight glycemic control, delaying nutrition, and early mobilization. Future challenges include identification of primary/secondary events during the time course of critical illness, the interplay between membrane excitability, bioenergetic failure and differential proteolysis, and finding new therapeutic targets by help of tailored animal models.

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“…Perez-Gonzalez et al (2017) concluded that regional anesthesia could amend the suppressive effects of surgery on human cells from avoiding harmful volatile anesthetics and opioids. Three studies (Deegan et al, 2010;O'Riain et al, 2005;Sultan, 2013), which focused on inflammatory mediators and surgical stress, demonstrated insignificant differences in markers of inflammation and stress response between regional and general anesthesia (…”

Section: Resultsmentioning

confidence: 99%

Anesthetic Use and Cancer Recurrence in the Surgical Oncological Patient: An Integrative Review

Hauser¹

2018

Preprint

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This integrative review compared anesthetic usage and its impact on the cancer patient.Immunosuppression from anesthesia can have major impacts on the human body's immune system and lead to a decrease in overall patient survival and an increase in cancer recurrence rates. A search was completed using electronic databases including CINAHL, PubMed Health, and Medline Plus. The studies were located with keyword searches and inclusion and exclusion criteria was used to locate a final 8 studies for the review. A critical appraisal was completed using Polit and Beck's critical analysis tables, displaying key characteristics of the studies chosen. Outcomes reviewed included overall survival rates, cancer recurrence rates, time to recurrence and biomarker identification.The findings presented more beneficial outcomes with regional anesthesia, but larger prospective randomized studies are needed to validate these findings. Regional anesthesia has shown to increase time to recurrence, decrease recurrence rates, and limit the increase in immune biomarkers. However, regional anesthesia does not fully support an increase in overall survival rates. More research and randomized control trials are warranted on this topic. Overall, this integrative review has supported the use of regional anesthesia for more positive outcomes in the oncological surgical patient over general anesthesia. Anesthetics and Cancer Recurrence in the Surgical Oncological Patient:An Integrative Review of the Literature Background/Statement of the ProblemAn estimated 234 million surgeries are undertaken every year world-wide (Weiser et al., 2008) and of this 234 million, an estimated 20% are related to cancer (Hoekstra et al., 2015). Cancer is a global epidemic, being the leading and most common cause of death worldwide (Torre et al., 2015). This is amplified by the increasing age and growth of our population. The rise in cancer cases is strongly associated with an increase in sedentary lifestyles, poor diets and smoking (Torre et al., 2015). The word 'cancer' constitutes immediate negative connotations for valid reasons. Each year in the United States over 1 million cases of individuals diagnosed with cancer are recorded (Le-Wendling, Nin, & Capdevila, 2015). In 2012, 14 million new cancer cases were documented, and 8.2 million cancer deaths occurred globally (Torre et al., 2015). An additional 1.6 million cases were diagnosed in 2016 and of these cases an estimated 33% will die from the developed disease (Bharati, Chowdhury, Bergese, & Ghosh, 2016). These staggering figures provide us with a clear picture of why cancer remains one the leading causes of mortality in the world. Increased risk factors for cancer developmentThreatened populations. Certain populations are at greater risk for cancer development, such as men and the elderly. The incidence in North America of cancer in men versus (vs.) women was 344:295 out of 100,000 (Torre et al., 2015). The cancer mortality rate per 100,000 of men vs. women was 123:91 (Torre et al., 2015). The underlying re...

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Paravertebral block can attenuate cytokine response when it replaces general anesthesia for cancer breast surgeries

Cited by 23 publications

References 34 publications

Impact of Regional Anesthesia on Recurrence, Metastasis, and Immune Response in Breast Cancer Surgery

Impact of Regional Anesthesia on Recurrence, Metastasis, and Immune Response in Breast Cancer Surgery

The Sick and the Weak: Neuropathies/Myopathies in the Critically Ill

Anesthetic Use and Cancer Recurrence in the Surgical Oncological Patient: An Integrative Review

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