Anesthesia in cancer patients

can anesthetic techniques and agents influence the outcome? A narrative review

Abstract

Introduction: Anesthesia in cancer patients represents a challenge in many ways: complex patients with various comorbidities and often undergoing adjuvant treatments. Surgical treatment is the first-line treatment in most cancer cases, and anesthesia is an essential step to make this treatment possible. The use of different anesthetic agents and techniques today is one of the potential factors that may influence cancer outcome. We reviewed some of the new concepts that have emerged in the literature regarding perioperative anesthetic care and the evolution of this population. Methods: A narrative and exploratory bibliographic study. A search was performed on the Medline and Scielo databases using the terms (((anesthesia) OR (anesthesia)) AND (cancer)) until November 2019, and 44 studies were included. Results: These studies discuss the specific role of various anesthetic agents, especially intravenous, inhalational and opioid hypnotic agents, and address the possible differences between anesthetic techniques. We included not only the anesthetic agents themselves but also the role of other agents frequently used in the perioperative period. Conclusions: Regional anesthesia techniques still need to be studied further but they may bring benefits to this population by assisting in perioperative pain control, reducing opioid consumption and inflammation triggered by the stress response. Not enough evidence exists to modify the agents and techniques used in anesthesia, but there are some indications of potential benefits for intravenous anesthesia, opioid-sparing multimodal analgesia techniques, and even for the use of some agents such as lidocaine and propofol. Little clinical evidence supports the use of fully opioid-free anesthesia aimed to reduce recurrence and optimize the outcome of the cancer patient, but this subject is being widely studied and soon there will be more news and evidence that may redirect perioperative anesthetic management.