Department of Anesthesiology and Intensive Care, Tohoku University Hospital, Sendai, Japan.
Curr Opin Anaesthesiol. 2012 Jun;25(3):376-84. doi: 10.1097/ACO.0b013e328352b4a8.
Along with the increasing population of elderly people in developed countries, anesthesiologists have increasing opportunities to anesthetize cancer patients in their routine work. However, no guideline of anesthesia procedures for cancer patients is available even though guidelines of operative procedures have been formulated for different types of cancer. This review provides recent findings related to the optimal choice of anesthetics and adequate anesthesia management for cancer patients.
The intrinsic weapon fighting cancer cells is competent immune cells, particularly CD4+ T helper 1-type cells, CD8+ cytotoxic T cells, and natural killer cells. However, surgical inflammation, some anesthetics, and inadvertent anesthesia management suppress these effector cells and induce suppressive immune cells, which render cancer patients susceptible to tumor recurrence and metastasis after surgery.
Accumulated basic and clinical data suggest that total intravenous anesthesia with propofol, cyclooxygenase antagonists, and regional anesthesia can decrease negative consequences associated with perioperative immunosuppression. Volatile anesthesia, systemic morphine administration, unnecessary blood transfusions, intraoperative hypoxia, hypotension, hypothermia, and hyperglycemia should be avoided.
随着发达国家老年人口的增加，麻醉师在日常工作中有越来越多的机会为癌症患者实施麻醉。然而，尽管已经为不同类型的癌症制定了手术程序指南，但仍没有针对癌症患者麻醉程序的指南。本综述提供了与癌症患者最佳麻醉选择和充分麻醉管理相关的最新发现。
与癌细胞作斗争的内在武器是具有免疫功能的细胞，特别是 CD4+T 辅助 1 型细胞、CD8+细胞毒性 T 细胞和自然杀伤细胞。然而，手术炎症、一些麻醉剂和意外的麻醉管理会抑制这些效应细胞，并诱导抑制性免疫细胞，使癌症患者在手术后容易复发和转移肿瘤。
积累的基础和临床数据表明，使用丙泊酚、环氧化酶拮抗剂和区域麻醉的全静脉麻醉可以降低围手术期免疫抑制相关的负面后果。应避免使用挥发性麻醉、全身吗啡给药、不必要的输血、术中缺氧、低血压、低体温和高血糖。
