Search

There is a paucity of literature regarding the effect of anesthetic techniques on antitumor immunity, especially in gall bladder malignancies. We designed a study to compare the effect of propofol‐based total intravenous anesthesia and sevoflurane‐based general anesthesia—on antitumor immunity, including tumor growth factor‐β (TGF‐β), T‐helper cell profile, and inflammatory markers. A pilot prospective randomized trial was conducted in 64 patients undergoing surgery for gall bladder malignancy under general anesthesia in a tertiary specialty cancer hospital. Adult cancer patients of ASA physical status I‐III fulfilling the inclusion criteria were randomized to either group S (sevoflurane‐based general anesthesia) or group T (propofol‐based total intravenous anesthesia). Preoperative (morning of surgery) and postoperative (24 h and 1 month after surgery) blood samples were obtained. Demographic profile and preoperative parameters were comparable between both groups. There was a statistically significant difference in the postoperative value of TGF‐β (higher in group T). There was a statistically significant difference in postoperative interleukin‐17A value (indicative of TH17 cells), and it was found to be higher in group S. Propofol‐based TIVA increases serum TGF‐β levels. At the same time, Sevoflurane modulates T‐helper cells‐based immunity to increase TH17 cells in patients with gall bladder cancer. Multiple larger studies will be required to validate the results and provide useful recommendations. [ABSTRACT FROM AUTHOR]

Byline: Vinod. Kumar, Deepti. Ahuja, Nishkarsh. Gupta, Sachidanand. Bharati, Rakesh. Garg, Seema. Mishra, K. Haresh, Subhash. Gupta, Sushma. Bhatnagar Background: Prostate cancer is a common cancer found in men worldwide. [...]

Byline: Anuja. Pandit, Vishwajeet. Singh, Sachidanand. Bharati, Seema. Mishra, Suryanarayana. Deo, Sushma. Bhatnagar Background and Aims: Cytoreduction and hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) cause numerous pathophysiological changes. The objective of this [...]

Background and Aims: Anesthetic management for brachytherapy require repeated exposure to anesthesia in elderly patients with comorbidities. The varying locations provide an anesthesiologist with further challenges. Material and Methods: We studied retrospectively anesthesia type, details of anesthetic techniques and complications that occurred in patients having received anesthesia for brachytherapy in our institute in the last 6 years. Categorical variables were described as frequency and percentage, and continuous variables described as median and interquartile range. For continuous variables, mean values compared using two sample t tests for independent samples. Results: The majority of patients were females who received brachytherapy for carcinoma cervix. A higher percentage of carcinoma breast and male genitourinary malignancies had comorbidities. Predominant side effects included 22 (1.85%) had hypotension, 19 (1.59%) had difficulty in putting spinal, 13 (1.09%) patients had tachycardia and 11 (0.92%) had headache in the postoperative period. Conclusion: Neuraxial block as anesthetic technique in pelvic brachytherapy using fentanyl as additive helped reduce the dose of local anesthetic and avoided the complications of high spinal. The choice of anesthesia can vary depending on the duration and site of brachytherapy keeping in consideration the patient's factors. [ABSTRACT FROM AUTHOR]

Psoas compartment block is an acceptable regional anaesthesia technique as a substitute to central neuraxial blockade for lower limb surgeries. Being a peripheral nerve block, it is considered relatively safe compared with the central neuraxial block. However, it can lead to some serious complications. Herein, we report a rare complication of total spinal anaesthesia following peripheral nerve stimulator-guided psoas compartment block. [ABSTRACT FROM AUTHOR]

Patients with peritoneal carcinomatosis were considered incurable with dismal survival rates till hyperthermic intraperitoneal chemotherapy after optimal cytoreductive surgery evolved. Perioperative management for these procedures is complex and involves an optimal cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy. In this article we highlight the perioperative concerns in these patients including anesthetic challenges, such as optimal fluid management, maintaining blood pressure, control of body temperature, coagulation and electrolyte derangement and renal toxicity of chemotherapeutic drugs. We have also discussed the postoperative problems and their management. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the notion about anesthesia as well as jejunostomy in patients with difficult airway.

Abstract: Study Objective: To assess the efficacy of oral granisetron versus oral ondansetron for preemptive antiemesis in women undergoing modified radical mastectomy. Design: Randomized, double-blind, controlled study. Setting: Metropolitan hospital. Patients: Ninety ASA physical status I and II hospitalized female patients, aged 18 to 65 y, scheduled for modified radical mastectomies. Interventions: Patients were assigned to receive orally placebo, granisetron 2 mg, or ondansetron 4 mg (n = 30 in each group) 1 h before induction of anesthesia. A standard general anesthetic technique and postoperative analgesia were used. Measurements: Postoperative nausea and vomiting and safety assessments were performed continuously 0 to 2, 2 to 6, 6 to 12, and 12 to 24 h after anesthesia. Main results: A complete response during 0 to 2 h after anesthesia was found in 43%, 63%, and 90% of patients who had received placebo, granisetron, or ondansetron, respectively; corresponding percentages of patients requiring rescue antiemetics were 40%, 17%, and 7%. Frequency of nausea and vomiting was low (less than 23%) after 2 h in the three groups. Observations of postoperative nausea and vomiting score and need for antiemetics at other time intervals (2 to 6, 6 to 12, and 12 to 24 h) were not significantly different among the three groups. Conclusion: Oral ondansetron 4 mg provided better preemptive antiemesis than oral granisetron 2 mg in the 2 h after modified radical mastectomy during general anesthesia. [Copyright &y& Elsevier]