title: 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.
authors.affiliation: Anesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, London, UK; Department of Anaesthesiology, Nippon Medical School, Tokyo, Japan.
authors.forename: Masae
authors.initials: M
authors.lastname: Iwasaki
authors.affiliation: Anesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, London, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Edmondson
authors.affiliation: Department of Anaesthesiology, Nippon Medical School, Tokyo, Japan.
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Sakamoto
authors.affiliation: Anesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, London, UK. Electronic address: d.ma@imperial.ac.uk.
authors.forename: Daqing
authors.initials: D
authors.lastname: Ma
mesh_terms: D000765:Anesthesia, Conduction; D000768:Anesthesia, General; D000777:Anesthetics / Q000494:pharmacology; D000818:Animals; D003072:Cognition Disorders / Q000209:etiology; D006801:Humans; D007109:Immunity / Q000187:drug effects; D009369:Neoplasms / Q000276:immunology*; D011183:Postoperative Complications / Q000209:etiology; D013312:Stress, Physiological; D013514:Surgical Procedures, Operative
chemical_list: D000777:Anesthetics
keywords: anesthetic/technique; cancer recurrence; organ failure; outcome; postoperative cognitive dysfunction; stress