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November24

Posted by:John Ellis
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Interesting and important article in Anesthesiology from UK “Long-term Survival for Patients Undergoing Volatile versus IV Anesthesia for Cancer Surgery: A Retrospective Analysis“. They say that pts rec’d roughly 1/2 and 1/2 inhaled vs propofol (~7000 pts over 3 yrs from cancer hospital).¬†Their retrospective findings:

Volatile inhalational anesthesia was associated with an HR of 1.80 (1.61 to 2.02) for the overall group on univariate analysis and an HR of 1.46 (1.31 to 1.64) after multivariable analysis for known confounders (table 3). Other variables associated with a significant increase in the hazard of death after multivariable analysis included age, male sex, blood transfusion, ASA score, and the presence of metastases at the time of surgery (table 3).

There is biologic plausability:

Studies both in vivo12 and more recently in patients undergoing surgery for breast cancer13 have found a differential effect of volatile inhalational anesthesia and propofol on natural killer cell function, with the former being shown to result in a marked reduction. This could lead to the survival of tumor cells released into the circulation in the perioperative period.

They do multiple adjustments for ASA, surgery type, age, etc. But they do not adjust for the anesthetists.

We know from NY State data that mortality varies 2-fold from top to bottom quartile of cardiac anesthesiologists.

What if better anesthetists use propofol???

“The magic is in the magician, not the wand???”




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