title: Taxane modulation of anesthetic sensitivity in surgery for nonmetastatic breast cancer.
abstract: OBJECTIVE
  The mechanism of action of commonly used general anesthetics is largely unknown. One hypothesized mechanism is through modulation of microtubule stability. Taxanes, a subset of chemotherapeutic drugs known to alter microtubule stability and commonly used to treat breast cancer, offer a natural experiment to test our hypothesis that patients exposed to taxanes prior to surgery, as compared to after surgery, would have a partial resistance to general anesthetics.
  The anesthetic record of adult women with nonmetastatic breast cancer was used to obtain changes in heart rate and blood pressure surrounding incision, and the amount of inhaled anesthetic agent, induction, and rescue drugs administered.
  
  
  RESULTS
  Change in blood pressure in response to incision was significantly higher in the neoadjuvant group (P = .03), whereas change in heart rate was not (P = .53). A greater amount of morphine was administered in the neoadjuvant group (26.3 vs 15.5 mg, P = .02), although not a higher concentration of inhaled anesthetics (P = .15).
  
  
  CONCLUSIONS
  These results suggest that the alteration of microtubule stability is one of a number of mechanisms of inhaled anesthetics.
authors.affiliation: University of Pennsylvania, Department of Anesthesiology. Electronic address: reshanno@uci.edu.
authors.forename: Regina E
authors.initials: RE
authors.lastname: Linganna
authors.affiliation: University of Pennsylvania, Department of Anesthesiology. Electronic address: levyw@uphs.upenn.edu.
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Levy
authors.affiliation: University of Pennsylvania, Department of Chemistry. Electronic address: ivandmo@sas.upenn.edu.
authors.forename: Ivan J
authors.initials: IJ
authors.lastname: Dmochowski
authors.affiliation: University of Pennsylvania, Department of Anesthesiology. Electronic address: roderic.eckenhoff@uphs.upenn.edu.
authors.forename: Roderic G
authors.initials: RG
authors.lastname: Eckenhoff
authors.affiliation: University of Pennsylvania, Department of Anesthesiology; Evidera, Outcomes Research. Electronic address: speckr@mail.med.upenn.edu.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Speck
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D018681:Anesthetics, General / Q000494:pharmacology*; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D001943:Breast Neoplasms / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D004347:Drug Interactions; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008870:Microtubules / Q000187:drug effects; D008875:Middle Aged; D012189:Retrospective Studies; D043823:Taxoids / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D018681:Anesthetics, General; D000970:Antineoplastic Agents; D043823:Taxoids
keywords: General anesthetic; Mechanism; Surgery; Taxane