Eficacia analgésica del sevoflurano tópico en heridas / Analgesic efficacy of topical sevoflurane on wounds

El sevoflurano es un anestésico derivado halogenado del éter dietílico que se presenta como un líquido volátil. Es ampliamente utilizado por vía inhalatoria para la inducción y el mantenimiento de la anestesia general, pues su perfil de seguridad es muy bueno. Además de su acción hipnótica, diversas experiencias preclínicas muestran que el sevoflurano y otros derivados halogenados del éter producen un efecto analgésico/anestésico importante cuando son administrados en su formulación líquida directamente al sistema nervioso central, concretamente a la médula espinal, pero clásicamente se les considera carentes de efecto analgésico a nivel periférico. Sin embargo, en los últimos años se están comunicando experiencias clínicas en las que el sevoflurano produce un efecto analgésico importante sobre heridas dolorosas cuando es irrigado en su presentación líquida sobre el lecho de dichas heridas. Este efecto analgésico se caracteriza por instaurarse en escasos minutos, ser lo bastante intenso como para permitir el desbridamiento mecánico de las heridas, y extenderse por espacio de varias horas. Referido a efectos adversos, hasta ahora no ha sido comunicado ninguno a nivel sistémico, y el efecto local más frecuentemente referido por los pacientes es prurito leve y transitorio. Hasta ahora las comunicaciones clínicas se limitan a casos clínicos aislados y series de casos, y es obvio que se precisa la realización de los pertinentes ensayos clínicos para establecer adecuadamente su papel en el tratamiento analgésico de las heridas dolorosas. Pero mientras estos ensayos clínicos se realizan, el empleo fuera de indicación de sevoflurano irrigado tópicamente sobre el lecho de heridas dolorosas es una alternativa analgésica de rescate a tener en cuenta en aquellas heridas de dolor refractario a los tratamientos habituales

Sevoflurane is a halogenated anesthetic derived from diethyl ether, which is presented as a volatile liquid. Administered by inhalation, it is widely used for the induction and maintenance of general anesthesia, as its safety profile is very good. In addition to their hypnotic action, various preclinical experiences show that sevoflurane and other halogenated ether derivatives produce an important analgesic/ anesthetic effect when administered in their liquid form directly to the central nervous system, specifically to the spinal cord. However, it is classically thought they lack analgesic effect at peripheral level. However, clinical experiences in which sevoflurane had an important analgesic effect on painful wounds when it was irrigated in its liquid presentation on the bed of such wounds have been reported in recent years. Such analgesic effect is characterized by being established in a few minutes, be intense enough to allow sharp debridement of the wounds, and last for several hours. Concerning adverse effects, it has been reported so far no case of systemic adverse events; only local adverse effects have been reported, the most frequently reported one being mild and transitory itching. For the moment, clinical communications are limited to isolated clinical cases and case series of patients; obviously, relevant clinical trials are required to adequately establish the role of topical sevoflurane in the analgesic treatment of painful wounds. But while conducting these clinical trials, the off-label use of topical sevoflurane irrigated on the bed of painful wounds may be an alternative option for the analgesic treatment of wounds with pain refractory to usual treatments

Patrones de infección asociada a los cuidados de salud en el paciente crítico postquirúrgico. Análisis prospectivo multivariante en una cohorte de pacientes / Patterns of healthcare-associated infections in postsurgical critical patients. Prospective multivariate analysis in a cohort of patients

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Crisis económica española y salud. Impacto clínico en el dolor crónico / Economic crisis and health in Spain. Clinical impact in chronic pain

Antecedentes: múltiples gobiernos europeos han reducido de forma considerable el gasto público en salud durante la crisis económica. Las posibles consecuencias de la crisis financiera sobre los resultados en la salud han comenzado a aparecer. La recesión también ha impulsado diversas reformas estructurales que han afectado a la prioridad otorgada a las políticas públicas. El propósito de este trabajo es analizar el posible impacto de las políticas de austeridad en la salud en España, y así entender la respuesta de los sistemas sanitarios europeos a la crisis financiera y políticas de austeridad. Material y métodos: estudio prospectivo de 206 pacientes en una Unidad de Dolor Crónico durante un periodo de dos años. Se evaluaron los tratamientos farmacológicos, invasivos y los resultados médicos de la unidad en función del nivel de ingresos del paciente. Resultados: la situación económica del paciente se correlacionó de forma estadísticamente significativa con el éxito del tratamiento médico (p = 0,01), así como en la aparición de diversos efectos adversos en relación al tratamiento médico (p < 0,01). Existe una fuerte evidencia de un efecto negativo estadísticamente significativo de la actual crisis financiera sobre los resultados de sanitarios. Conclusiones: las decisiones políticas y su respuesta a las crisis económicas han acentuado los efectos no deseados sobre la salud pública. El gobierno y los diversos líderes deben hallar fórmulas eficientes para mitigar sus efectos (AU)

Background: Many European governments have abundantly cut down public expenditure on health during the financial crisis. Consequences of the financial downturn on health outcomes have begun to emerge. The recession has also driven structural reforms, and affected the priority given to public policies. The purpose of this paper is to analyse how austerity impacts health in Spain and better understand the response of European health systems to the financial crisis. Material and methods: Prospective study of 206 patients over a period of two years. Was evaluated various pharmacological and invasive treatments and medical outcomes in Chronic Pain Unit depending on the patient’s income level. Results: The economic situation of the patient is statistically significantly correlated with the success of medical treatment (p = 0.01) and the occurrence of various adverse effects in relation to medical treatment (p < 0.01). Results provide strong evidence of a statistically significant negative effect of the financial crisis on health trends. Conclusions: Policy decisions about how to respond to economic crises have pronounced and unintended effects on public health. The governance and leadership find ways to mitigate its effects (AU)

Bloqueo intraarticular y de ramas sensoriales de los nervios obturador y femoral en cuadro de osteonecrosis y artrosis de cabeza femoral / Joint and sensory branch block of the obturator and femoral nerves in a case of femoral head osteonecrosis and arthritis

La inervación sensitiva de la articulación de la cadera es compleja. El bloqueo intraarticular y de las ramas sensitivas de los nervios obturador y femoral es eficaz para tratar el dolor producido por diversas enfermedades de cadera, y pudiera ser una opción a considerar en determinadas circunstancias. Estas circunstancias pueden ser alto riesgo quirúrgico-anestésico por el estado basal del paciente o la existencia de sobrepeso importante, en otras ocasiones el médico traumatólogo considera que es mejor retrasar la artroplastia, al menos durante algún tiempo (AU)

The sensory innervation of the hip joint is complex. The joint and sensory branch block of the obturator and femoral nerves is effective for treating the pain caused due to different hip diseases. This could be an option to be considered in certain circumstances such as, being a surgical-anaesthetic high risk, or if there is significant overweight, It could also be useful on other occasions if the traumatoligist considers that it is better to delay hip replacement for a limited period (AU)

[Joint and sensory branch block of the obturator and femoral nerves in a case of femoral head osteonecrosis and arthritis]. / Bloqueo intraarticular y de ramas sensoriales de los nervios obturador y femoral en cuadro de osteonecrosis y artrosis de cabeza femoral.

The sensory innervation of the hip joint is complex. The joint and sensory branch block of the obturator and femoral nerves is effective for treating the pain caused due to different hip diseases. This could be an option to be considered in certain circumstances such as, being a surgical-anaesthetic high risk, or if there is significant overweight, It could also be useful on other occasions if the traumatoligist considers that it is better to delay hip replacement for a limited period.

Efecto antidepresivo de dosis subanestésicas de ketamina en el postoperatorio de una paciente con depresión no controlada / Effect of sub-anaesthetic doses of ketamine in the postoperative period in a patient with uncontrolled depression

Estudios recientes indican que la infusión intravenosa de clorhidrato de ketamina (antagonista de los receptores N-metil-D-aspartato) conlleva una rápida reducción de la sintomatología depresiva. Una mujer de 42 años, con cáncer de mama y depresión mayor resistente a tratamiento médico recibió una infusión intravenosa de 0,3mg/kg de ketamina en 90min durante 5 días consecutivos. Se apreció una disminución significativa de la sintomatología evaluada mediante la escala de depresión de Hamilton de 22 a 13 (-41%) con un efecto mantenido a los 14 días. Se discute el posible mecanismo terapéutico(AU)

Recent studies indicate that the intravenous infusion of ketamine hydrochloride (an N-methyl-D-aspartate receptor antagonist) leads to a rapid reduction in depressive symptoms. A 42 year-old woman with breast cancer and major depression resistant to medical treatment received a 90 minute intravenous infusion of 0.3mg/kg ketamine for 5 consecutive days. A significant reduction from 22 to 13 (-41%) was observed in the symptoms assessed using the Hamilton scale, with the effect maintained for 14 days. The possible therapeutic mechanism is discussed(AU)

[Effect of sub-anaesthetic doses of ketamine in the postoperative period in a patient with uncontrolled depression]. / Efecto antidepresivo de dosis subanestésicas de ketamina en el postoperatorio de una paciente con depresión no controlada.

Recent studies indicate that the intravenous infusion of ketamine hydrochloride (an N-methyl-D-aspartate receptor antagonist) leads to a rapid reduction in depressive symptoms. A 42 year-old woman with breast cancer and major depression resistant to medical treatment received a 90 minute intravenous infusion of 0.3 mg/kg ketamine for 5 consecutive days. A significant reduction from 22 to 13 (-41%) was observed in the symptoms assessed using the Hamilton scale, with the effect maintained for 14 days. The possible therapeutic mechanism is discussed.

Bloqueo caudal en dolor crónico lumbar. ¿Es necesario el apoyo radiológico para disminuir los fallos de la técnica? / No disponible

Introducción: las infiltraciones de esteroides epidurales no ofrecen beneficio a largo plazo en el tratamiento del dolor de espalda, pero pueden ser eficaces en los pacientes con dolor radicular lumbosacro agudo. Los bloqueos epidurales vía caudal de esteroides son eficaces en el alivio sintomático a corto plazo (evidencia de nivel II), así como a largo plazo (nivel de evidencia III). Objetivos: evaluar la eficacia del bloqueo caudal con y sin guía fluoroscópica. Material y métodos: estudio prospectivo, observacional y descriptivo para evaluar la tasa de fallos de la realización del bloqueo caudal mediante la técnica "a ciegas" respecto a la guiada por radiología. El análisis estadístico incluyó chi2 de Mantel y Haensel, t de Student y test ANOVA, considerándose una p < 0,05 con significación estadística. Resultados: se realizaron 129 bloqueos epidurales caudales en 89 pacientes por cuadros de dolor crónico. La tasa global de éxito del bloqueo caudal con la técnica a ciegas fue de un 65,11%. Existen diferencias estadísticamente significativas en la tasa de fallos de la técnica a ciegas para las variables: experiencia profesional del médico anestesiólogo y la presencia de obesidad. La mal posición más frecuente en nuestra cohorte es la colocación subcutánea de la aguja, que representa un 80% de los casos (36/45). Conclusiones: recomendamos el uso de la visión radiológica para realizar los bloqueos epidurales caudales (AU)

Introduction: epidural steroid injections offer no longterm benefit for the treatment of low back pain but may be effective in the small subset of patients with acute lumbosacral radicular pain. Caudal epidural steroid injection was effective in producing short-term improvement (level II evidence) as well as long-term relief (level III evidence). Objetives: to evaluate of the effectiveness of the caudal epidural block under fluoroscopic guidance. Material and methods: prospective, observational and descriptive study to assess the failure rates of caudal block using the technique "blind" with respect to radiological vision. Statistical comparisons were based on the chi2 test, the long-rank test, t test and ANOVA test, considering a statistically significant result p < 0.05. Results: we performed 129 caudal epidural blocks in 89 patients for chronic pain conditions. The overall success rate of caudal block with a blind technique was of 65.11%. Statistically significant differences in the rate of technical failure of the blind for the variables professional experience of the anesthesiologist and the presence of obesity. The most common malposition in our cohort is the subcutaneous placement of the needle. Conclusions: we recommend the use of radiological vision to perform the epidural caudal procedures (AU)

Analysis of results, quality indicators, and postsurgical complications in an outpatient dermatological surgery program.

OBJECTIVE: To evaluate the results of an outpatient program for major dermatological surgery in patients with a range of skin conditions. METHODS: We undertook a retrospective, observational study of patients who underwent scheduled dermatological surgery as outpatients in a public hospital between 2004 and 2007. The most common procedures were excision of basal cell or squamous cell carcinoma with or without graft reconstruction. The rates of substitution (of inpatient procedures), cancellation, hospital admission, and readmission were analyzed along with service utilization and systemic complications arising within the first 72 h of surgery. Variables were analyzed as relative frequencies. The occurrence of complications during the study period was analyzed by chi square test. RESULTS: A total of 2789 patients underwent surgery during the study period, and of those, 2757 procedures were performed on an outpatient basis (overall substitution rate, 17.99%). The service utilization was 74.36%. Fourteen patients were admitted to hospital following surgery (2.62%), and of those 12 were admitted immediately (85.71%). Nine patients had serious complications (cardiovascular, neurological, metabolic, or infectious), representing a proportional risk of 1:59. Less serious complications (hypertension, nausea, vomiting, and vasovagal syncope) requiring hospital admission occurred in 25 patients. CONCLUSIONS: Major surgery undertaken on an outpatient basis is an excellent multidisciplinary surgical care model that allows well-selected patients to be treated effectively, safely, and efficiently. A small percentage of postoperative complications of varying severity can still occur despite patients' meeting optimal criteria for success. Fortunately, however, the rate of mortality is practically zero.

Análisis de resultados, índices de calidad y complicaciones extrahospitalarias de un programa de cirugía ambulatoria en Dermatología / Analysis of Results, Quality Indicators, and Postsurgical Complications in an Outpatient Dermatological Surgery Program

Objetivo: Evaluar los resultados de un programa de cirugía mayor ambulatoria en pacientes intervenidos quirúrgicamente de diversas patologías dermatológicas en nuestro hospital. Métodos: Estudio observacional retrospectivo que incluye los pacientes intervenidos de forma programada en el periodo 2004-2007 en un hospital público realizándose diferentes procedimientos quirúrgicos de forma ambulatoria, siendo la cirugía de exéresis de carcinomas basocelulares y espinocelulares, con y sin injerto, la operación mayoritaria. Se han analizado diversos índices (sustitución, suspensión, ingresos, reingresos), así como el rendimiento quirúrgico y las complicaciones sistémicas que surgieron dentro de las primeras 72 horas tras la cirugía. La medición de las variables se realizó mediante frecuencias relativas. El análisis utilizado para la evolución de las complicaciones en el periodo de estudio fue la Chi cuadrado de tendencias. Resultados: 2.789 pacientes fueron intervenidos en el periodo indicado, de los que 2.757 se operaron de forma ambulatoria (índice de sustitución global del 17,99%). El rendimiento quirúrgico medio fue 74,36%. El índice de ingresos tras la cirugía fue 2,62% (14 pacientes), siendo ingresos inmediatos en el 85,71% de los casos (12). Nueve pacientes sufrieron complicaciones graves (cardiovasculares, neurológicas, metabólicas e infecciosas), representando un riesgo proporcional de 1:59. En 25 pacientes aparecieron complicaciones de menor gravedad (hipertensión arterial, náuseas, vómitos, síncope vasovagal) que requirieron ingreso hospitalario. Conclusiones: La cirugía mayor ambulatoria (CMA) es un excelente modelo organizativo de asistencia quirúrgica multidisciplinar, que permite tratar pacientes bien seleccionados de una manera efectiva, segura y eficiente. A pesar del cumplimiento de los requisitos óptimos, existe un porcentaje pequeño de complicaciones postoperatorias de gravedad variable, aunque afortunadamente la mortalidad es prácticamente nula (AU)

Objective: To evaluate the results of an outpatient program for major dermatological surgery in patients with a range of skin conditions. Methods: We undertook a retrospective, observational study of patients who underwent scheduled dermatological surgery as outpatients in a public hospital between 2004 and 2007. The most common procedures were excision of basal cell or squamous cell carcinoma with or without graft reconstruction. The rates of substitution (of inpatient procedures), cancellation, hospital admission, and readmission were analyzed along with service utilization and systemic complications arising within the first 72hours of surgery. Variables were analyzed as relative frequencies. The occurrence of complications during the study period was analyzed by chi square test. Results: A total of 2789 patients underwent surgery during the study period, and of those, 2757 procedures were performed on an outpatient basis (overall substitution rate, 17.99%). The service utilization was 74.36%. Fourteen patients were admitted to hospital following surgery (2.62%), and of those 12 were admitted immediately (85.71%). Nine patients had serious complications (cardiovascular, neurological, metabolic, or infectious), representing a proportional risk of 1:59. Less serious complications (hypertension, nausea, vomiting, and vasovagal syncope) requiring hospital admission occurred in 25 patients. Conclusions: Major surgery undertaken on an outpatient basis is an excellent multidisciplinary surgical care model that allows well-selected patients to be treated effectively, safely, and efficiently. A small percentage of postoperative complications of varying severity can still occur despite patients’ meeting optimal criteria for success. Fortunately, however, the rate of mortality is practically zero (AU)

Infiltración del ganglio impar y caudal en el manejo de la coccigodinia traumática rebelde al tratamiento analgésico convencional / Infiltration of ganglion impar and caudal in the management of traumatic coccydynia refractory to conventional analgesic treatment

Introducción. La coccigodinia es un término referido al dolor en la región del cóccix. La mayor parte de casos se asocian a una movilidad anormal del cóccix que puede provocar un proceso crónico inflamatorio que conduce a la degeneración de esta estructura. El tratamiento conservador debe ser de elección en este cuadro, y puede consistir en terapias manuales (masajes, estiramiento, manipulación y postural) inyecciones locales de esteroides o anestésicos. Material y métodos. Estudio retrospectivo de una cohorte histórica de 23 pacientes con clínica de coccigodinia traumática sin respuesta a tratamiento médico. Se trataron con infiltración del ganglio impar y/o bloqueo caudal con lidocaina 1% y triancinolona 60-80mg bajo control radioscópico. De estos 23 pacientes, 21 estaban disponibles y completaron un cuestionario de evaluación del efecto de la infiltración del ganglio impar el bloque y/o el bloque caudal. Resultados. Se consideraron excelentes los resultados obtenidos en 16 de los 21 pacientes con coccigodinia traumática. En cinco pacientes los resultados eran moderados o pobres, aunque ninguno describiera aumento o empeoramiento del dolor después de las infiltraciones. El procedimiento no se asoció a complicaciones mayores. Conclusión. El bloqueo del ganglio impar y/o el bloqueo caudal conllevó un control del dolor coccígeo en la mayoría de pacientes (AU)

Introduction. Coccydynia is a term that refers to pain in the region of the coccyx. Most cases are associated with abnormal mobility of the coccyx which may trigger a chronic inflammatory process leading to degeneration of this structure. Non-surgical management remains the gold standard treatment for coccydynia, consisting of decreased sitting, seat cushioning, coccygeal massage, stretching, manipulation, local injection of steroids or anaesthetics, and postural adjustments. Material and methods. A retrospective study of 23 patients who underwent treatment for coccydynia and failed to respond to conservative management. They were treated by radiologically guided infiltration of the ganglion blockade impar and/or caudal blockade with 1% lidocaine 60-80mg triamcinolone. Of these 23 patients, 21 were available for clinical review and completed a questionnaire giving their assessment of the effect of the infiltration of the ganglion impar block and/or caudal block. Results. Good results were obtained in 16 of the 21 patients with coccydynia due to trauma. In five patients the results were moderate or poor, although none described worse pain after the operation. They are no complications after the infiltration. Conclusion. Ganglion impar block and/or caudal block offered satisfactory relief of pain in the majority of patients regardless of the cause of their symptoms (AU)

[Post-cardiac arrest syndrome after general anesthesia: role of therapeutic hypothermia and remifentanil]. / Síndrome de postparada cardiaca tras anestesia general. papel de la hipotermia terapéutica y remifentanilo.

Moderate therapeutic hypothermia is often used in aneurysm surgery and is therefore a technique anesthesiologists are familiar with. We report the case of a patient who had entered into a coma after cardiac arrest in the postanesthetic recovery unit during central venous catheterization; the patient required 35 minutes of advanced cardiopulmonary resuscitation before heart rhythm and tissue perfusion were restored. The protocol for treating post-cardiac arrest syndrome included therapeutic hypothermia, which was maintained for 12 hours. The patient was extubated after 2 days, with no neurologic deficit. Post-cardiac arrest syndrome is associated with multiple biochemical reactions which are attenuated by hypothermia. Currently available evidence does not allow definitive recommendations regarding the different techniques for inducing therapeutic hypothermia, the ideal temperature to maintain, the duration, or the rewarming process. Further studies are required.

Síndrome de postparada cardiaca tras anestesia general. Papel de la hipotermia terapéutica y remifentanilo / Post-cardiac arrest syndrome after general anesthesia: role of therapeutic hypothermia and remifentanil

La hipotermia terapéutica moderada se ha empleado frecuentemente en la cirugía aneurismática. Por tanto, es una técnica conocida para los anestesiólogos. Describimos el caso de un paciente en coma tras una parada cardiaca intrahospitalaria en la unidad de reanimación durante la cateterización de una vía central, que requirió 35 minutos de reanimación cardiopulmonar avanzada antes de la restauración del ritmo cardiaco y perfusión tisular. El protocolo para tratar el síndrome postparada cardiaca incluyó hipotermia terapéutica que fue mantenida durante 12 horas. El paciente fue extubado al 2º día sin déficit neurológico. El síndrome postparada cardiaca se asocia a reacciones bioquímicas múltiples, que son suprimidas con hipotermia. Actualmente, la evidencia médica disponible es insuficiente para hacer recomendaciones definitivas entre las diferentes técnicas para inducir la hipotermia terapéutica, la temperatura óptima de mantenimiento, duración y el proceso de recalentamiento. Son necesarios estudios adicionales en este campo(AU)

Moderate therapeutic hypothermia is often used in aneurysm surgery and is therefore a technique anesthesiologists are familiar with. We report the case of a patient who had entered into a coma after cardiac arrest in the postanesthetic recovery unit during central venous catheterization; the patient required 35 minutes of advanced cardiopulmonary resuscitation before heart rhythm and tissue perfusion were restored. The protocol for treating post-cardiac arrest syndrome included therapeutic hypothermia, which was maintained for 12 hours. The patient was extubated after 2 days, with no neurologic deficit. Post-cardiac arrest syndrome is associated with multiple biochemical reactions which are attenuated by hypothermia. Currently available evidence does not allow definitive recommendations regarding the different techniques for inducing therapeutic hypothermia, the ideal temperature to maintain, the duration, or the rewarming process. Further studies are required(AU)

Pseudoaneurisma subclavio izquierdo iatrogénico / No disponible

No disponible

[Assessment of neurologic function and complications in a retrospective cohort of patients with acute spinal cord injury due to trauma treated with large-dose methylprednisolone]. / Evaluación de la lesión neurológica y complicaciones médicas en una cohorte histórica de pacientes con lesión medular aguda traumática tras tratamiento con megadosis de metilprednisolona.

BACKGROUND AND OBJECTIVE: Methylprednisolone was used to improve neurologic recovery from spinal cord injury in the National Acute Spinal Cord Injury Studies (NASCIS). Debate over this use led to further research and a 2002 report stating that there was insufficient evidence to support this application as a standard therapy. Our aim was to retrospectively assess this application in a cohort of patients with spinal cord injury. METHODS: Retrospective cohort study of patients admitted to the intensive care unit (ICU) between 1997 and 2007 with a diagnosis of spinal cord injury due to trauma. The patients were grouped according to medical treatment received into a methylprednisolone group and a no-methylprednisolone group. We assessed change in neurologic function on the impairment scale of the American Spinal Injury Association on ICU admission and on discharge. We also recorded medical complications in each group. Cox multiple regression analysis was used to analyze differences between treatments. RESULTS: No significant differences were detected in neurologic outcome on discharge from the ICU (odds ratio [OR], 1.57; 95% confidence interval [CI], 0.69-3.54). The methylprednisolone-treated patients had more medical complications such as hyperglycemia (OR, 5.67; 95% CI, 1.85-17.31) or gastrointestinal bleeding (OR, 19.16; 95% CI, 1.64-223.30) than the patients who did not receive methylprednisolone. CONCLUSIONS: In this retrospective study, methylprednisolone was unrelated to improvement in neurologic outcome after acute spinal cord injury on ICU discharge although the patients treated with this drug were at greater risk of metabolic complications.

Influencia de la técnica anestésica en el riesgo de recidiva tumoral en el cáncer de mama tras la cirugía / No disponible

La enfermedad metastásica es la principal causa de muerte relacionada con el cáncer. La técnica anestésica y los diversos fármacos empleados pueden interactuar con el sistema inmune celular y modificar los resultados a largo plazo. Hay un interés particular en la actualidad en el efecto de la anestesia regional, que pudiera ser beneficiosa en ciertas cirugías oncológicas. Análisis retrospectivos han demostrado un beneficio de la anestesia-analgesia paravertebral en los resultados tras cirugía del cáncer de mama. La evidencia disponible sugiere que los agentes anestésicos tienen efectos a corto plazo reversible en la inmunidad del huésped, y no existe todavía ninguna evidencia que sugiera que una técnica de anestesia se asocie con mejores resultados en pacientes con cáncer(AU)

Metastatic disease is the most important cause of cancer-related death. Anaesthetic technique and drug choice can interact with the cellular immune system and effect long-term outcome. There is particular interest at present in the effect of regional anaesthesia, which appears to be beneficial. Retrospective analyses have shown an outcome benefit for paravertebral analgesia for breast cancer surgery. Available evidence suggests that anaesthetic agents have short-term reversible effects on host immunity, and there is as yet no evidence to suggest that one anaesthetic technique is associated with better outcomes in cancer patients(AU)