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The belief that anesthetic technique has little influence on long-term patient outcomes is being challenged by accumulating evidence that anesthetic management may exert longer-term influences. This review examines aspects of anesthetic management that may affect postoperative outcomes.
Adequate delivery of oxygen to the tissues is a major requirement for resisting surgical site infection (SSI) and successful surgical wound healing. Many of the factors controlling tissue perfusion and oxygenation are influenced by anesthetic management. Regional anesthesia and analgesia have been shown to prevent adverse effects of cancer surgery by preventing the neuroendocrine surgical stress response, eliminating or reducing the need for general anesthesia and minimizing opioid requirement. Emerging evidence indicates that long-term infection risk and cardiovascular morbidity/mortality may be optimized by avoiding perioperative hyperglycemia in both diabetic and nondiabetic patients and by administering insulin via a continuous intravenous infusion to avoid large swings in blood glucose values. The immunomodulatory effects of transfused allogeneic blood products can possibly increase the risk of postoperative infections and cancer recurrence.
Perioperative β-blockade has been hypothesized to reduce the risk of cardiovascular events following noncardiac surgery. However, if trial data demonstrate a benefit at one year clinicians and patients will have to balance this benefit against the 30 day excess of death and stroke with a β-blocker. The administration of nitrous oxide has been associated with an increased long-term risk of myocardial infarction but not of death or stroke. Even though adequate treatment of acute postoperative pain is required, there is no consistent evidence that it prevents the development of chronic postsurgical pain (CPSP); however, current literature suggests that regional anesthesia may help prevent the development of chronic postoperative pain. Evidence indicates that altered intraoperative physiology may influence postoperative cognitive dysfunction (POCD) and longer-term outcomes, but further large-scale prospective studies are required to investigate the possible prolonged effects of short-acting anesthetics on the elderly brain.
Evidence indicates that anesthetic management may exert a number of influences on longer-term postoperative outcomes. The authors believe, “Further prospective, randomized, large-scale, human trials with long-term follow-up are required to clarify the association between anesthesia and cancer recurrence, neurotoxicity and the developing brain and long-term POCD in the elderly.”