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Blood transfusion and patient blood management in cancer patients 癌症患者输血与患者血液管理
IF 4.7 3区 医学
Best Practice & Research-Clinical Anaesthesiology Pub Date : 2025-03-01 DOI: 10.1016/j.bpa.2025.04.004
Simone Lindau, Andrea U. Steinbicker
{"title":"Blood transfusion and patient blood management in cancer patients","authors":"Simone Lindau,&nbsp;Andrea U. Steinbicker","doi":"10.1016/j.bpa.2025.04.004","DOIUrl":"10.1016/j.bpa.2025.04.004","url":null,"abstract":"<div><div>Anemia is common in cancer patients and linked to higher mortality, longer hospital stays, and reduced survival. Iron deficiency and the second most common form of anemia, anemia of chronic disease caused by elevated hepcidin levels, limit iron availability. Although red blood cell (RBC = transfusions quickly raise hemoglobin levels, they are associated with increased risks of tumor recurrence, infections, and reduced cancer-specific survival. Intravenous iron therapy and/or erythropoiesis-stimulating agents (ESAs) are effective alternatives to manage anemia. Patient Blood Management (PBM) offers a structured strategy to reduce transfusions by multiple approaches such as preoperative iron therapy, restrictive transfusion strategy and conserving blood during surgery. Clinical studies have shown that PBM significantly reduced transfusion rates, lowered infection risks, and shortened hospital stays without compromising safety. An individualized therapeutic approach seems beneficial in oncologic patients.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 1","pages":"Pages 50-56"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Return to intended oncologic treatment: Definitions, perioperative prognostic factors, and interventions 回归预期的肿瘤治疗：定义、围手术期预后因素和干预措施
IF 4.7 3区 医学
Best Practice & Research-Clinical Anaesthesiology Pub Date : 2025-03-01 DOI: 10.1016/j.bpa.2025.03.009
Carlos E. Guerra-Londono , Alexander Schreck , Arun Muthukumar , Juan J. Guerra-Londono
{"title":"Return to intended oncologic treatment: Definitions, perioperative prognostic factors, and interventions","authors":"Carlos E. Guerra-Londono ,&nbsp;Alexander Schreck ,&nbsp;Arun Muthukumar ,&nbsp;Juan J. Guerra-Londono","doi":"10.1016/j.bpa.2025.03.009","DOIUrl":"10.1016/j.bpa.2025.03.009","url":null,"abstract":"<div><div>In the cancer survivorship journey, many patients require both medical and surgical oncologic treatments to improve survival. The return to intended oncologic treatment (RIOT) is a relatively new concept addressing the continuity of cancer treatment after surgery. While general definitions have been published, thresholds and minimal clinically important differences (MCID) have not been standardised. For many cancers, a threshold for delayed RIOT is 6–8 weeks, while the MCID in colorectal cancer may approximate 4 weeks. Studies addressing RIOT have shown multiple demographics, socioeconomic, institutional, surgical, and postoperative factors associated with a difference in rate and time to RIOT. The most influential of these variables is the surgical approach. While research on the effect of enhanced recovery after surgery on RIOT has increased, the literature is still in its early stages. Finally, the effect of anaesthetic interventions on RIOT has been largely unexplored.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 1","pages":"Pages 14-22"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Challenges of (postoperative) cancer patients in the ICU ICU中（术后）癌症患者的挑战
IF 4.7 3区 医学
Best Practice & Research-Clinical Anaesthesiology Pub Date : 2025-03-01 DOI: 10.1016/j.bpa.2025.03.005
Nora Jahn , Philipp Metnitz , Robert Sucher , Robert Karitnig , Sven Laudi , Hans Michael Hau
{"title":"Challenges of (postoperative) cancer patients in the ICU","authors":"Nora Jahn ,&nbsp;Philipp Metnitz ,&nbsp;Robert Sucher ,&nbsp;Robert Karitnig ,&nbsp;Sven Laudi ,&nbsp;Hans Michael Hau","doi":"10.1016/j.bpa.2025.03.005","DOIUrl":"10.1016/j.bpa.2025.03.005","url":null,"abstract":"<div><div>Advancements in the treatment of cancers and organ failures have significantly improved survival rates and increased the number of cancer patients requiring and benefiting from intensive care unit (ICU) admission. As a result, critical care has become a vital component of modern cancer treatment. While, in many ways, intensive care for cancer patients is similar to that for other severely ill individuals, there are specific challenges unique to this group that require specialized expertise and knowledge. Effectively managing critically ill cancer patients requires proficiency in oncology, critical care, and palliative medicine. Therefore, cancer specialists must be well-versed in the essential aspects of intensive care for these patients. This review offers an overview of the latest approaches in the personalized management of critically ill cancer patients.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 1","pages":"Pages 57-70"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pain management in cancer patients: Could opioids or NSAIDs influence outcomes? 癌症患者的疼痛管理：阿片类药物或非甾体抗炎药会影响结果吗？
IF 4.7 3区 医学
Best Practice & Research-Clinical Anaesthesiology Pub Date : 2025-03-01 DOI: 10.1016/j.bpa.2025.03.007
Laura Smith , Ashly Mary Lal , Patrice Forget
{"title":"Pain management in cancer patients: Could opioids or NSAIDs influence outcomes?","authors":"Laura Smith ,&nbsp;Ashly Mary Lal ,&nbsp;Patrice Forget","doi":"10.1016/j.bpa.2025.03.007","DOIUrl":"10.1016/j.bpa.2025.03.007","url":null,"abstract":"<div><div>Pain management in cancer patients is crucial, yet its implications on tumour progression and long-term outcomes remain an area of ongoing debate. Opioids, while effective for severe pain, may have immunomodulatory and tumour-promoting effects, whereas NSAIDs, particularly selective COX-2 inhibitors, could exert anti-tumour properties through modulation of inflammation and the tumour microenvironment. However, conflicting clinical evidence and methodological limitations hinder definitive conclusions. This review examines the current literature on the oncological effects of analgesics, highlighting the need for high-quality randomized controlled trials, biomarker-driven research, and a focus on patient-centred outcomes. Future studies should integrate advanced cancer subtyping and predictive modelling to optimize analgesic strategies while minimizing potential oncological risks. By addressing these gaps, clinicians can refine perioperative and long-term pain management approaches to improve both symptom control and cancer prognosis.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 1","pages":"Pages 45-49"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Local anesthetics, regional anesthesia and cancer biology 局部麻醉，区域麻醉和癌症生物学
IF 4.7 3区 医学
Best Practice & Research-Clinical Anaesthesiology Pub Date : 2025-03-01 DOI: 10.1016/j.bpa.2025.03.001
Eduardo Nunez-Rodriguez , Juan P. Cata , Tobias Piegeler
{"title":"Local anesthetics, regional anesthesia and cancer biology","authors":"Eduardo Nunez-Rodriguez ,&nbsp;Juan P. Cata ,&nbsp;Tobias Piegeler","doi":"10.1016/j.bpa.2025.03.001","DOIUrl":"10.1016/j.bpa.2025.03.001","url":null,"abstract":"<div><div>Local anesthetics (LAs) have been widely used for over a century in perioperative care. Emerging evidence suggests that LAs impact on cancer cell biology through multiple mechanisms, including modulation of tumor cell proliferation, apoptosis, and metastasis, as well as in processes related to the tumor microenvironment such as angiogenesis and the immune response. These effects are attributed to LAs effect on membrane proteins, such as voltage gated sodium channels (VGSC) and caveolin-1, oncogenic pathways, such as PI3K/AKT/mTOR and RAS/MAPK/ERK axis, and gene transcription signaling regulation, including intermediates such as NF-κB and STAT3. Furthermore, LAs modulate cancer cells by promoting caspase activation and inducing oxidative stress, as well as regulating different organelle's function and structure. LAs role as adjuvant agents for stablished and experimental chemotherapeutic drugs have further been described in multiple <em>in vitro</em> experiments. <em>In vivo</em> models have also been used to demonstrate that LAs might be able to reduce tumor burden and metastasis in animals, highlighting their potential role in cancer treatment. However, despite promising preclinical findings, further research is needed to establish clinical relevance and optimize the use of LAs in oncological surgery. The aim of this review article is to summarize the currently available preclinical evidence of the effects of LAs and regional anesthesia on cancer spread.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 1","pages":"Pages 30-39"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Perioperative care of the cancer patient 癌症患者的围手术期护理
IF 4.7 3区 医学
Best Practice & Research-Clinical Anaesthesiology Pub Date : 2025-03-01 DOI: 10.1016/j.bpa.2025.05.002
Juan P. Cata , Tobias Piegeler
{"title":"Perioperative care of the cancer patient","authors":"Juan P. Cata ,&nbsp;Tobias Piegeler","doi":"10.1016/j.bpa.2025.05.002","DOIUrl":"10.1016/j.bpa.2025.05.002","url":null,"abstract":"","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 1","pages":"Pages 1-2"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Local anaesthetics and regional anaesthesia and outcome in cancer patients – What is the clinical evidence? 局部麻醉和区域麻醉对癌症患者的影响-临床证据是什么？
IF 4.7 3区 医学
Best Practice & Research-Clinical Anaesthesiology Pub Date : 2025-03-01 DOI: 10.1016/j.bpa.2025.05.001
Mohd S. Ramly , Daniela Ionescu , Donal J. Buggy
{"title":"Local anaesthetics and regional anaesthesia and outcome in cancer patients – What is the clinical evidence?","authors":"Mohd S. Ramly ,&nbsp;Daniela Ionescu ,&nbsp;Donal J. Buggy","doi":"10.1016/j.bpa.2025.05.001","DOIUrl":"10.1016/j.bpa.2025.05.001","url":null,"abstract":"<div><div>Cancer remains a large healthcare and socio-economic burden worldwide. New cancer cases are predicted to increase to over 35 million cases in 2050. Surgery remains the mainstay curative approach for solid tumour. Despite advancements in surgery and oncology diagnostics and therapeutics, cancer often recurs. Surgery and anaesthesia produce significant physiological changes that may dampen immune function, thus promoting cancer progression. The effects of regional anaesthesia and local anaesthetics have been explored to mitigate the risk of cancer recurrence. In this review, we summarise the current evidence of regional anaesthesia and local anaesthetics on cancer outcomes. Despite positivity in preclinical trials, prospective randomised trials have not produced convincing results. Other than the peritumoral local anaesthetic infiltration, studies have only suggested a neutral effect on long term outcome. Until new positive studies are available, regional anaesthesia and local anaesthetic use should be based on clinical grounds, not on potential oncological outcome benefit.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 1","pages":"Pages 40-44"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prehabilitation: Stepping beyond exercise in patients with frailty and cancer 康复：在虚弱和癌症患者中超越运动
IF 4.7 3区 医学
Best Practice & Research-Clinical Anaesthesiology Pub Date : 2025-03-01 DOI: 10.1016/j.bpa.2025.03.008
Zhaosheng Jin , Jonathan Aminov , Giancarlo Sabetta , Jacob Gordon , Sergio D. Bergese
{"title":"Prehabilitation: Stepping beyond exercise in patients with frailty and cancer","authors":"Zhaosheng Jin ,&nbsp;Jonathan Aminov ,&nbsp;Giancarlo Sabetta ,&nbsp;Jacob Gordon ,&nbsp;Sergio D. Bergese","doi":"10.1016/j.bpa.2025.03.008","DOIUrl":"10.1016/j.bpa.2025.03.008","url":null,"abstract":"<div><div>Cancer is one of the leading causes of morbidity and mortality. In patients who require oncological surgery, frailty is associated with increased risk of perioperative adverse events, which can lead to delay in subsequent oncological care. Additionally, cancer and neoadjuvant therapy both contribute to diminished physiological reserve and increased incidence of frailty. Prehabilitation involves a bundle of preoperative intervention with the goal of improving patients’ physiological reserve and promoting better recovery after surgery. While prehabilitation is frequently associated with the delivery of preoperative physical exercise interventions, there is increasing recognition that a multimodal approach should be employed to optimize outcomes.</div><div>Nutritional, educational and psychobehavioral interventions are commonly employed as components of multimodal prehabilitation. There are also other emerging novel interventions, including cognitive prehabilitation. As with all effective perioperative initiatives, effective implementation of prehabilitation often requires a multidisciplinary effort. This review will discuss both the established and the novel prehabilitation interventions, as well as the interaction between prehabilitation and other perioperative pathways.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 1","pages":"Pages 3-13"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Volatiles vs. TIVA – Is there a difference in cancer patients 挥发物与TIVA -在癌症患者中有区别吗
IF 4.7 3区 医学
Best Practice & Research-Clinical Anaesthesiology Pub Date : 2025-03-01 DOI: 10.1016/j.bpa.2025.03.002
Bente FH. Dubois, Markus W. Hollmann
{"title":"Volatiles vs. TIVA – Is there a difference in cancer patients","authors":"Bente FH. Dubois,&nbsp;Markus W. Hollmann","doi":"10.1016/j.bpa.2025.03.002","DOIUrl":"10.1016/j.bpa.2025.03.002","url":null,"abstract":"<div><div>Cancer incidence continues to rise, with 20 million new cases and 9.7 million cancer-related deaths reported in 2022. With the vast majority of these patients requiring anaesthesia. However, despite surgical resection, nearly one-third of patients experience local recurrence or distant metastases. Perioperative factors, including surgical stress and anaesthetic technique, may influence recurrence, though tumour biology remains not fully understood.</div><div>The impact of total intravenous anaesthesia (TIVA) versus inhalation anaesthesia (IA) on oncological outcomes has attracted growing interest. While some studies suggest a potential advantage of propofol-based TIVA, the probability of a clinically significant effect remains low. The existing literature consists mainly of retrospective studies and small randomised trials (RCT's) with methodological limitations.</div><div>Currently, there is no strong evidence that TIVA or IA has a meaningful impact on cancer-free survival. This review critically examines the available research and presents an alternative perspective on this controversial topic.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 1","pages":"Pages 23-29"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Optimising recovery after caesarean delivery 优化剖宫产后的恢复
IF 4.7 3区 医学
Best Practice & Research-Clinical Anaesthesiology Pub Date : 2024-09-01 DOI: 10.1016/j.bpa.2024.10.003
Sarah Ciechanowicz , Evy De Greef , Marc Van de Velde , Pervez Sultan
{"title":"Optimising recovery after caesarean delivery","authors":"Sarah Ciechanowicz ,&nbsp;Evy De Greef ,&nbsp;Marc Van de Velde ,&nbsp;Pervez Sultan","doi":"10.1016/j.bpa.2024.10.003","DOIUrl":"10.1016/j.bpa.2024.10.003","url":null,"abstract":"<div><div>Caesarean delivery is the most performed inpatient surgery worldwide, with rates expected to rise. Optimising maternal recovery benefits not only the mother, but also the newborn and society. Enhanced Recovery After Caesarean delivery (ERAC) protocols standardize the approach to perioperative management of patients in order to accelerate early postoperative maternal rehabilitation. Implementation of ERAC protocols has been associated with improved maternal and neonatal outcomes including shorter hospital stay, lower pain scores and opioid consumption, fewer complications, higher maternal satisfaction, and greater breastfeeding success. Higher-quality evidence is needed to support and evaluate ERAC protocols as they continue to be refined with the application of regional analgesia and an individualized approach to pain management. Recent work has described the postpartum period as a complex multidimensional process. A holistic approach to measuring postpartum recovery could provide valuable insights for tailoring interventions and supporting services to promote maternal recovery after caesarean delivery.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"38 3","pages":"Pages 199-208"},"PeriodicalIF":4.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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