Gudaitytė Jūratė, Dvylys Dominykas, Šimeliūnaitė Indrė
Department of Anaesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Acta Med Litu. 2017;24(2):121-127. doi: 10.6001/actamedica.v24i2.3493.
The aim is to present the major effects of cancer treatment (chemotherapy, radiotherapy, surgery) that the anaesthesiologist should consider preoperatively, and to review techniques of the analgesic management of the disease.
To summarize the major challenges that cancer patients present for the anaesthesiologists, a literature review was conducted. Articles presenting evidence or reviewing the possible effects of anaesthetics on cancer cells were also included. Online databases of Science Direct, PubMed, and ELSEVIER, as well as reference lists of included studies were searched. Articles published from 2005 to 2016 were selected.
Anaesthesiologists should pay attention to patients receiving chemotherapy and its side effects on organ systems. Bleomycin causes pulmonary damage, anthracyclines are cardiotoxic, and platinum-based chemotherapy agents are nephrotoxic. A lot of chemotherapy agents lead to abnormal liver function, vomiting, diarrhoea, etc. Surgery itself is suspected to be associated with an increased risk of metastasis and recurrence of cancer. Regional anaesthesia and general anaesthesia with propofol should be used and volatile agents should be avoided to prevent cancer patients from perioperative immunosuppression that leads to increased risk of cancer recurrence. Pain management for palliative patients remains a major problem.
To provide the best treatment for cancer patients, cooperation of anaesthesiologists with oncologists and surgeons becomes imperative. It has been established that anaesthetic techniques and drugs could minimize the perioperative inflammation. However, further research of the perioperative "onco-anaesthetic" is needed.
旨在介绍麻醉医生术前应考虑的癌症治疗（化疗、放疗、手术）的主要影响，并综述该疾病镇痛管理的技术。
为总结癌症患者给麻醉医生带来的主要挑战，进行了文献综述。还纳入了提供证据或综述麻醉药对癌细胞可能影响的文章。检索了科学Direct、PubMed和爱思唯尔的在线数据库以及纳入研究的参考文献列表。选取了2005年至2016年发表的文章。
麻醉医生应关注接受化疗的患者及其对器官系统的副作用。博来霉素会导致肺部损伤，蒽环类药物具有心脏毒性，铂类化疗药物具有肾毒性。许多化疗药物会导致肝功能异常、呕吐、腹泻等。手术本身被怀疑与癌症转移和复发风险增加有关。应使用区域麻醉和丙泊酚全身麻醉，避免使用挥发性麻醉剂，以防止癌症患者围手术期免疫抑制，从而导致癌症复发风险增加。姑息治疗患者的疼痛管理仍然是一个主要问题。
为给癌症患者提供最佳治疗，麻醉医生与肿瘤学家和外科医生的合作变得至关重要。已经证实麻醉技术和药物可以使围手术期炎症最小化。然而，需要对围手术期“肿瘤麻醉”进行进一步研究。
