scholarly journals Anesthesia and Cancer, Friend or Foe? A Narrative Review

2021 ◽  
Vol 11 ◽  
Author(s):  
Julio Montejano ◽  
Vesna Jevtovic-Todorovic
Keyword(s):  
General Anesthesia ◽  
Surgical Intervention ◽  
Inflammatory Responses ◽  
Perioperative Period ◽  
Cancer Surgery ◽  
Time Period ◽  
Age Cohort ◽  
Cancer Cell Survival ◽  
Ultimate Question ◽  
Short Time

Cancer remains the leading cause of death worldwide with close to 10 million deaths reported annually. Due to growth of the advanced age cohort in our population, it is predicted that the number of new cancer cases diagnosed between now until 2035 is to reach potentially 24 million individuals, a staggering increase in a relatively short time period. For many solid tumors, surgical resection along with chemotherapy is the best available approach to a potential cure which leads to almost 80% of cancer patients undergoing at least one surgical procedure during the course of their disease. During surgical intervention, the exposure to general anesthesia can be lengthy, complex and often involves various modalities resulting in an important question as to the role, if any, anesthesia may play in primary recurrence or metastatic conversion. Many components of the stress and inflammatory responses exhibited in the perioperative period can contribute to cancer growth and invasion. The agents used to induce and maintain general anesthesia have variable interactions with the immune and neuroendocrine systems and can influence the stress response during surgery. Thus, debating the best type of anesthesia that would help to attenuate sympathetic and/or pro-inflammatory responses while modulating cytokine release and transcription factors/oncogenes remains at the forefront. This may affect inducible cancer cell survival and migratory abilities not only intra-operatively, but also during the immediate post-operative phase of recovery. The ultimate question becomes how and whether the choice of anesthesia may influence the outcomes of cancer surgery with two major approaches being considered, i.e., regional and general anesthesia as well as the various hypnotics, analgesics and sympatholytics commonly used. In this review, we will address the latest information as to the role that anesthesia may play during cancer surgery with specific focus on primary recurrence and metastasis.

scholarly journals Multimodal anesthesia and analgesia at the stages of the perioperative period in children with abdominal surgical pathology

2021 ◽  
Vol 24 (1) ◽  
pp. 27-31
Author(s):  
Elmira A. Satvaldieva ◽  
Otabek Ya. Fayziev ◽  
Anvar S. Yusupov
Keyword(s):  
General Anesthesia ◽  
Postoperative Period ◽  
Surgical Intervention ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Postoperative Recovery ◽  
Surgical Pathology ◽  
Abdominal Organ ◽  
Epidural Blockade ◽  
Abdominal Operations

Aim of the study was assess both the effectiveness and safety of anesthetic management and optimizing postoperative anesthesia under conditions of multimodal anesthesia and analgesia during abdominal operations in children. Patients and methods. The authors examined 58 children aged 1 to 17 years with abdominal operations (malformations, diseases, and abdominal organ injuries). To ensure anesthetic protection, patients underwent combined general anesthesia with propofol and fentanil (induction) with inhalation of sevoflurane + propofol intra venous (maintenance) in combination with epidural blockade with bupivacaine. Results. According to surgical intervention, the arrangement of perioperative analgesic protection provided a favorable correction of the hemodynamic status of patients, a decrease in inhalation anesthetic, promoted a smooth course of the postoperative period, a long painless period, an excellent psychoemotional background, and rapid postoperative recovery.

scholarly journals The Chiari I malformation

2019 ◽  
Vol 24 (3) ◽  
pp. 217-226 ◽  
Author(s):  
Samuel G. McClugage ◽  
W. Jerry Oakes
Keyword(s):  
Surgical Intervention ◽  
Chiari I Malformation ◽  
Proper Patient Selection ◽  
Time Period ◽  
Treatment Paradigm ◽  
History Of ◽  
Chiari I ◽  
Degenerative Disorder ◽  
Short Time ◽  
Chiari Malformations

As with many pathologies, the course of our understanding of the Chiari I malformation (CIM) has developed extensively over time. The early descriptions of the Chiari malformations by Hans Chiari in 1891 opened the door for future classification and research on this topic. However, even over a long timeframe, our understanding of the pathophysiology and, more importantly, treatment, remained in its infancy. As recently as the 1970s, CIM was not discussed in popular neurology textbooks. Syringomyelia is listed as a degenerative disorder with no satisfactory treatment. Radiation therapy was considered an option in treatment, and surgery was thought to play no role. During the last 40 years, equivalent to the duration of a neurosurgical career, our understanding of the pathophysiology and natural history of CIM, coupled with modern MRI, has improved the treatment paradigm for this patient population. More importantly, it has given us evidence confirming that CIM is a disorder responsive to surgical intervention, giving patients once thought to be destined for lifelong disability a comparatively normal life after treatment. The purpose of this article is to offer a review of CIM and its important associated entities. The authors will discuss the evolution in understanding of the Chiari malformation and, importantly, distinguish between symptomatic CIM and asymptomatic tonsillar ectopia, based on imaging and presenting symptomatology. They will discuss techniques for surgical intervention, expected outcomes, and complications after surgery. Proper patient selection for surgery based on appropriate symptomatology is tantamount to achieving good surgical outcomes in this population, separating those who can be helped by surgery from those who are unlikely to improve. While our knowledge of the Chiari malformations continues to improve through the efforts of clinical and basic science researchers, surgeons, and patients, our current understanding of these entities represents a monumental improvement in patient care over a relatively short time period.

World Economy: Prospects and Barriers for Recovery

2012 ◽  
pp. 61-83 ◽  
Author(s):  
M. Ershov
Keyword(s):  
World Economy ◽  
Western World ◽  
Short Time Period ◽  
Market Segments ◽  
Junk Bonds ◽  
The Past ◽  
Time Period ◽  
The Us ◽  
Global Liquidity ◽  
Short Time

According to the latest forecasts, it will take 10 years for the world economy to get back to “decent shape”. Some more critical estimates suggest that the whole western world will have a “colossal mess” within the next 5–10 years. Regulators of some major countries significantly and over a short time‑period changed their forecasts for the worse which means that uncertainty in the outlook for the future persists. Indeed, the intensive anti‑crisis measures have reduced the severity of the past problems, however the problems themselves have not disappeared. Moreover, some of them have become more intense — the eurocrisis, excessive debts, global liquidity glut against the backdrop of its deficit in some of market segments. As was the case prior to the crisis, derivatives and high‑risk operations with “junk” bonds grow; budget problems — “fiscal cliff” in the US — and other problems worsen. All of the above forces the regulators to take unprecedented (in their scope and nature) steps. Will they be able to tackle the problems which emerge?

Effect of short-term use of oral contraceptive pills on intraocular pressure

2020 ◽  
Vol 35 (3) ◽  
Author(s):  
Tayyaba Gul Malik ◽  
Hina Nadeem ◽  
Eiman Ayesha ◽  
Rabail Alam
Keyword(s):  
Oral Contraceptive ◽  
Childbearing Age ◽  
Short Term ◽  
Oral Contraceptive Pills ◽  
Contraceptive Pills ◽  
Time Period ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Short Time

Objective: To study the effect of short-term use of oral contraceptive pills on intra-ocular pressures of women of childbearing age.   Methods: It was a comparative observational study, conducted at Arif memorial teaching hospital and Allied hospital Faisalabad for a period of six months. Hundred female subjects were divided into two groups of 50 each. Group A, included females, who had been taking oral contraceptive pills (OCP) for more than 6 months and less than 36 months. Group B, included 50 age-matched controls, who had never used OCP. Ophthalmic and systemic history was taken. Careful Slit lamp examination was performed and intraocular pressures (IOP) were measured using Goldman Applanation tonometer. Fundus examination was done to rule out any posterior segment disease. After collection of data, we analyzed and compared the intra ocular pressures between the two groups by using ANOVA in SPSS version 21.   Results: Average duration of using OCP was 14.9 months. There was no significant difference of Cup to Disc ratios between the two groups (p= 0.109). However, significant difference was noted between the IOP of OCP group and controls. (p=0.000). Conclusion: OCP significantly increase IOP even when used for short time period.

Preoperative preparation of alcohol and psychoactive substances-addicted patients

2011 ◽  
Vol 58 (2) ◽  
pp. 151-155
Author(s):  
Ivan Dimitrijevic ◽  
Zoran Zoricic ◽  
Miodrag Milenovic ◽  
Ivan Palibrk ◽  
Draga Dimitrijevic ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Postoperative Care ◽  
Surgical Intervention ◽  
Elective Surgery ◽  
Perioperative Period ◽  
Psychoactive Substance ◽  
Preoperative Preparation ◽  
Psychoactive Substances ◽  
Key Issues ◽  
Proper Diagnosis

Proper diagnosis of psychoactive substance abuse and addiction, as well as acute intoxication, withdrawal syndrome and overdosing are of great importance in patients who are preparing for surgical intervention. There are some specific details in their preoperative preparation whether they underwent emergency or elective surgery. Good knowledge of the characteristics of psychoactive substance abuse and addiction, interaction of psychoactive substances and anesthetics and any other drugs that could be used in the perioperative period is important especially for anastesiologist. In this work we present key issues for recognizing theese patients as well as some guidelines for adequate preoperative preparation and postoperative care.

scholarly journals General anesthesia with remimazolam in a patient with mitochondrial encephalomyopathy: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuji Suzuki ◽  
Matsuyuki Doi ◽  
Yoshiki Nakajima
Keyword(s):  
Lactic Acidosis ◽  
General Anesthesia ◽  
Mitochondrial Disease ◽  
Muscle Relaxation ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Mitochondrial Encephalomyopathy ◽  
Anesthesia Induction ◽  
General Anesthetic ◽  
Anesthetic Agents

Abstract Background Systemic anesthetic management of patients with mitochondrial disease requires careful preoperative preparation to administer adequate anesthesia and address potential disease-related complications. The appropriate general anesthetic agents to use in these patients remain controversial. Case presentation A 54-year-old woman (height, 145 cm; weight, 43 kg) diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes underwent elective cochlear implantation. Infusions of intravenous remimazolam and remifentanil guided by patient state index monitoring were used for anesthesia induction and maintenance. Neither lactic acidosis nor prolonged muscle relaxation occurred in the perioperative period. At the end of surgery, flumazenil was administered to antagonize sedation, which rapidly resulted in consciousness. Conclusions Remimazolam administration and reversal with flumazenil were successfully used for general anesthesia in a patient with mitochondrial disease.

scholarly journals Political ideology and vaccination willingness: implications for policy design

2021 ◽  
Author(s):  
Marc Debus ◽  
Jale Tosun
Keyword(s):  
Side Effects ◽  
Political Ideology ◽  
Policy Design ◽  
Public Support ◽  
Individual Freedom ◽  
Short Time Period ◽  
Successful Development ◽  
Individual Level ◽  
Time Period ◽  
Short Time

AbstractThe COVID-19 pandemic has forced governments to impose major restrictions on individual freedom in order to stop the spread of the virus. With the successful development of a vaccine, these restrictions are likely to become obsolete—on the condition that people get vaccinated. However, parts of the population have reservations against vaccination. While this is not a recent phenomenon, it might prove a critical one in the context of current attempts to manage the COVID-19 pandemic. Consequently, the task of designing policies suitable for attaining high levels of vaccination deserves enhanced attention. In this study, we use data from the Eurobarometer survey fielded in March 2019. They show that 39% of Europeans consider vaccines to cause the diseases which they should protect against, that 50% believe vaccines have serious side effects, that 32% think that vaccines weaken the immune system, and that 10% do not believe vaccines are tested rigorously before authorization. We find that—even when controlling for important individual-level factors—ideological extremism on both ends of the spectrum explains skepticism of vaccination. We conclude that policymakers must either politicize the issue or form broad alliances among parties and societal groups in order to increase trust in and public support for the vaccines in general and for vaccines against COVID-19 in particular, since the latter were developed in a very short time period and resulted—in particular in case of the AstraZeneca vaccine—in reservations because of the effectiveness and side effects of the new vaccines.

scholarly journals The effect of opioid-free anesthesia on the quality of recovery after gynecological laparoscopy: study protocol for a prospective randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jae Yen Song ◽  
Hoon Choi ◽  
Minsuk Chae ◽  
Jemin Ko ◽  
Young Eun Moon
Keyword(s):  
General Anesthesia ◽  
Assessment Tool ◽  
Controlled Trial ◽  
Perioperative Period ◽  
Postoperative Outcomes ◽  
Control Group ◽  
Quality Of Recovery ◽  
Gynecological Laparoscopy ◽  
Prospective Randomized Controlled Trial

Abstract Background Because of the indiscriminate use of opioids during the perioperative period, opioid-free anesthesia (OFA) has been increasingly required. Nevertheless, the studies on the detailed techniques and effects of OFA are not sufficient. The Quality of Recovery-40 (QoR-40) questionnaire is a validated assessment tool for measuring recovery from general anesthesia. However, no study has used the QoR-40 to determine if OFA leads to better recovery than standard general anesthesia. Therefore, we aim to perform this study to determine the effects of OFA using dexmedetomidine and lidocaine on the quality of recovery as well as the various postoperative outcomes. Methods The participants (n = 78) will be allocated to one of the two groups; the study group will receive bolus and infusion of dexmedetomidine and lidocaine, and the control group will receive remifentanil infusion during general anesthesia for gynecological laparoscopy. The other processes including anesthetic and postoperative care will be performed similarly in the two groups. Intraoperative hemodynamic, anesthetic, and nociceptive variables will be recorded. Postoperative outcomes such as QoR-40, pain severity, and opioid-related side effects will be assessed. Additionally, an ancillary cytokine study (inflammatory cytokine, stress hormone, and reactive oxygen species) will be performed during the study period. Discussion This will be the first study to determine the effect of OFA, using the combination of dexmedetomidine and lidocaine, on the quality of recovery after gynecological laparoscopy compared with standard general anesthesia using remifentanil. The findings from this study will provide scientific and clinical evidence on the efficacy of OFA. Trial registration ClinicalTrials.gov NCT04409964. Registered on 28 May 2020

scholarly journals Local Anesthetics and Recurrence after Cancer Surgery-What’s New? A Narrative Review

2021 ◽  
Vol 10 (4) ◽  
pp. 719
Author(s):  
Sarah D. Müller ◽  
Jonathan S. H. Ziegler ◽  
Tobias Piegeler
Keyword(s):  
Tumor Cells ◽  
Circulating Tumor Cells ◽  
Local Anesthetics ◽  
Experimental Studies ◽  
Perioperative Period ◽  
Cancer Surgery ◽  
Narrative Review ◽  
Future Research ◽  
Inflammatory Stress ◽  
Research Activities

The perioperative use of regional anesthesia and local anesthetics is part of almost every anesthesiologist’s daily clinical practice. Retrospective analyses and results from experimental studies pointed towards a potential beneficial effect of the local anesthetics regarding outcome—i.e., overall and/or recurrence-free survival—in patients undergoing cancer surgery. The perioperative period, where the anesthesiologist is responsible for the patients, might be crucial for the further course of the disease, as circulating tumor cells (shed from the primary tumor into the patient’s bloodstream) might form new micro-metastases independent of complete tumor removal. Due to their strong anti-inflammatory properties, local anesthetics might have a certain impact on these circulating tumor cells, either via direct or indirect measures, for example via blunting the inflammatory stress response as induced by the surgical stimulus. This narrative review highlights the foundation of these principles, features recent experimental and clinical data and provides an outlook regarding current and potential future research activities.

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