Impact of anaesthetic technique on survival in colon cancer: a review of the literature.

An oncological surgical resection is the mainstay of treatment for potentially curable colon cancer. At the time of surgery, a large fraction of patients do harbour-although not visibly-minimal residual disease at the time of surgery. The immunosuppression that accompanies surgery may have an effect on disease recurrence and survival. Regional or neuraxial anaesthetic techniques like epidural anaesthesia may suppress immune function less than opioid analgesia, by reducing stress response and significantly reducing exposure to opioids. Consistent with this hypothesis, regional anaesthetic techniques have been associated with lower recurrence rates in breast cancer and prostate cancer. Results for colon cancer, however, are contradictory. In this review of the literature we describe all studies addressing the association of the use of epidural anaesthesia and survival in colon cancer surgery.

Clinical results with the acoustic puncture assist device, a new acoustic device to identify the epidural space.

UNLABELLED: Sixty patients scheduled for lumbar epidural anesthesia were included in a study in which we evaluated the efficacy of localizing the epidural space by means of an acoustic signal. A prototype of an acoustic puncture assist device, connected to the epidural needle by an extension tube, generated the pressure needed to perform the epidural puncture and translated this pressure into corresponding acoustic and visible signals. The device frees the anesthesiologist to handle the epidural needle with both hands and to detect the epidural space by means of these signals. In all 60 patients (100%), the epidural space was successfully located by using the acoustic signal. In all cases, this was confirmed by the pressure measurement, which proved to be a reliable indicator for correct identification of the epidural space. We conclude that it is possible to locate the epidural space by means of the acoustic puncture assist device. The method proved to be reliable, safe, and simple in this study. The benefits of this new epidural puncture technique include better needle control, teaching, control of correct catheter placement, and documentation. The last can be an important adjunct to anesthesia practice. IMPLICATIONS: The authors demonstrate that it is possible to identify the epidural space by an acoustic and visible signal. An experimental setup constructed for this purpose makes the epidural puncture procedure audible and visible.