July 27, 2010

In the August 2010 BJA …

Anaesthesia and cancer outcomes

Outcome from cancer surgery is often measured by the incidence of recurrence. There are obviously quite a number of factors relating to the patient and to their management which may influence this outcome. It has been proposed that these factors may include the anaesthetic technique and drugs used. This subject is comprehensively reviewed by Snyder and Greenberg (pages 106–15). They conclude that while there is some evidence, and potential mechanisms, for adverse effects of morphine and beneficial effects of regional techniques, there is the need for large-scale prospective studies. This subject is also addressed in a retrospective study of patients receiving neuraxial or general anaesthesia for brachytherapy for cervical cancer (Ismail et al., pages 145–9). In this study of 132 patients, the authors found no difference in recurrence or survival rates.

Coagulopathy in trauma

Severe trauma is associated with major blood loss and defective coagulation. The mechanisms involved and the role of fibrinogen in the treatment of trauma-induced coagulopathy are reviewed by Fries and Martini (pages 116–21). They recommend early intervention with fibrinogen. In an accompanying Editorial, Spahn and Ganter (pages 103–5) expand on the concept of individual goal-directed management of coagulation defects in trauma patients. A case report (Iqbal et al., pages 168–71) adds a timely reminder that acute anaphylaxis can precipitate fibrinolysis. The authors recommend monitoring using thromboelastography.

Postoperative analgesia

Provision of high-quality postoperative pain relief is an essential part of anaesthesia care and can be a factor in the patient’s recovery milestones. A number of studies in this month’s issue look at this important subject. A comparison of peri-articular infiltration and continuous femoral nerve block after knee arthroplasty (Carli et al., pages 185–95) found better postoperative analgesia and better functional outcome in the femoral block group. The addition of oral celecoxib to epidural analgesia resulted in better pain scores in thoracotomy patients, but no change in postoperative complications (Senard et al., pages 196–200). In a group of patients undergoing laparoscopic cholecystectomy (Peng et al., pages 155–61) pre- and post-operative pregabalin produced better pain score only in the immediate postoperative period. Finally a laboratory study explored the potential postoperative analgesic effects of choline, through a reduced inflammatory response (Rowley et al., pages 201–7).