naa a22 4500 510743331 CHVBK 20180411083036.0 cr unu---uuuuu 180411e20131201xx s 000 0 eng 10.1007/s12630-013-0037-1 doi (NATIONALLICENCE)springer-10.1007/s12630-013-0037-1 Impact of anesthesia for cancer surgery: Continuing Professional Development [Elektronische Daten] [James Green, Ban Tsui] Impact de l'anesthésie sur la chirurgie oncologique Purpose: A number of original publications and review articles have addressed the issue of perioperative immune modulation and cancer outcome. The objective of this module is to review current understanding surrounding the pathways involved and the evidence implicating commonly used anesthetic agents. Principal findings: Drugs commonly used in anesthetic practice have been shown to affect various components of the immune system in laboratory animal and human in vitro models. It has been hypothesized that these effects may favour tumour recurrence and metastasis formation. Inhalational agents and opiates have potential negative immunomodulatory effects; on the other hand, regional anesthesia and propofol may have positive effects on immune function modulation. However, the clinical relevance of these studies to human cancer outcome is unknown since clinical trials are equivocal, and results of in vitro and animal model studies cannot be extrapolated to clinical practice. Furthermore, there is a lack of rigorous clinical trials demonstrating clinical outcome benefit for one technique over another. It remains unclear how anesthetic drugs influence the immune system in relation to tumour cell elimination and clinical cancer outcome. Conclusions: Recommendations for a specific anesthetic technique based on cancer outcome alone cannot be made. A pragmatic solution would be to offer regional anesthesia in isolation or combined with propofol infusion to cancer patients if appropriate and if local expertise is available. Regional anesthesia offers excellent analgesia, a low incidence of postoperative nausea and vomiting, and a favourable immunological profile based on current understanding of laboratory evidence. Canadian Anesthesiologists' Society, 2013 Green James Department of Anesthesiology and Pain Medicine, University of Alberta, 8-120 Clinical Sciences Building, T6G 2G3, Edmonton, AB, Canada aut Tsui Ban Department of Anesthesiology and Pain Medicine, University of Alberta, 8-120 Clinical Sciences Building, T6G 2G3, Edmonton, AB, Canada aut Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer US; http://www.springer-ny.com 60/12(2013-12-01), 1248-1269 0832-610X 60:12<1248 2013 60 12630 https://doi.org/10.1007/s12630-013-0037-1 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12630-013-0037-1 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Green James Department of Anesthesiology and Pain Medicine, University of Alberta, 8-120 Clinical Sciences Building, T6G 2G3, Edmonton, AB, Canada aut NATIONALLICENCE 700 1- Tsui Ban Department of Anesthesiology and Pain Medicine, University of Alberta, 8-120 Clinical Sciences Building, T6G 2G3, Edmonton, AB, Canada aut NATIONALLICENCE 773 0- Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer US; http://www.springer-ny.com 60/12(2013-12-01), 1248-1269 0832-610X 60:12<1248 2013 60 12630 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer