THIS MONTH IN Anesthesiology

Abstract

The concept that the μ-opioid receptor may be involved in tumor progression is discussed.This lecture promotes pursuing a redesign of perioperative healthcare.This study suggests that exploration of the μ-opioid receptor in non-small cell lung carcinoma merits further study both as a diagnostic and therapeutic option.Anesthetic- or surgical-related etiologies of perioperative nerve injury are reviewed.Unbundling of consciousness, connectedness, and responsiveness is critical for the future development of anesthesia.Previous studies have suggested interactions between opioid genetics, tumor growth, and clinical effects of morphine. In this long term study, 2,039 patients with breast cancer were genotyped and followed for clinical outcomes. Patients genotyped with the A118G μ-opioid receptor polymorphism had less breast cancer–specific mortality at 10 yr. Breast cancer–specific mortality was significantly reduced in patients with one or more copies of the G allele (P < 0.001) for invasive cases. Mortality was significantly decreased in patients with A/G and G/G phenotypes compared with A/A (P = 0.006). This study supports further investigation between opioid genetics, pain management, and cancer survival.There is conflicting literature regarding a patient's need for preoperative blood typing and screening. This study reviewed anesthesia information management system data from 160,207 scheduled noncardiac adult cases at a single hospital. Procedures could be defined to have minimal estimated blood loss (< 50 ml) based on low incidence of transfusion and low incidence of hemoglobin being checked preoperatively. Type and screen was unnecessary when the confidence intervals for erythrocyte transfusion were less than 5%. These data may allow development of a new method for determining which patients require preoperative type and screen. See the accompanying Editorial View on page 749 Use of perioperative epidural anesthesia and analgesia during cancer resections may avoid immunosuppressive recurrence triggers. Using the Medicare-Surveillance, Epidemiology, and End Results database, the authors compared survival and cancer recurrence rates for resection of colorectal cancer in patients who received perioperative epidural anesthesia and analgesia to those who did not. Of 42,151 patients, 5-yr survival was similar between groups (61% and 55% in the epidural group and the nonepidural groups, respectively). Although there was a significant association between epidural use and improved survival (hazard ratio = 0.91), after adjustment for covariates there was no significant reduction of recurrence in this group (odds ratio = 1.05). This study does not support an association between perioperative epidural use and decreased cancer recurrence in patients with nonmetastatic colorectal cancer undergoing resection.