• Tumour Recurrence and the Anaesthetist
    Link:bja.oxfordjournals.org/content/105/2/106.full.pdf
    • Largely based on animal studies but a growing area of interest
    • Potentially BAD
      • Anaesthetic related
        • Thiopentone
          • Reduce NK cell activity
        • Ketamine
          • Reduce NK cell activity
        • Volatiles
          • Reduce NK cell activity
        • Pain
        • Blood transfusion
          • Immune modulation
        • Morphine
          • Reduce NK cell activity
        • Fentanyl
          • Reduce NK cell activity
        • N₂O
          • Acceleration of lung and liver mets in animal studies
          • No evidence of adverse outcome in colorectal recurrence in human studies
        • ACE(i)
          • May increase breast cancer recurrence
        • Epo
      • Surgically related
        • Handling of tumour
        • Increased local/systemic growth factors after surgery
        • Peri-op immune supression due to surgery
        • Decrease in anti-angiogenesis factors from primary tumour
    • Potentially GOOD
      • β-blockers
        • Anti-angiogenesis
      • Statins
        • Anti-angiogenic & anti-inflammatory
      • Tramadol
        • Improves NK cell action
      • NSAIDS/COX2 inhibitors
      • Regional techniques
        • LA has cytotoxic effect
      • ? Propofol
        • Conflicting studies