La période périopératoire de chirurgie carcinologique : un moment crucial ! L’anesthésie locorégionale prévient-elle la récidive des cancers ? [The perioperative period in cancer surgery: a critical moment! Is there a role for regional anesthesia in preventing cancer recurrence?].

National audienceSurgical treatment of cancer is usually necessary but it can paradoxically aggravate the patient outcome by increasing the risk of recurrence. Many perioperative factors have been shown to contribute to the dissemination of the tumor: surgery itself, stress, inflammation, pain, anaesthetic drugs, blood transfusion, etc. The type of anaesthesia chosen in the cancer patient could then be crucial and influence the evolution of the disease. Experimental, preclinical and retrospective studies have suggested that a regional anesthesia associated or not with a general anesthesia for carcinologic surgery might reduce the risk of cancer recurrence. This text reviews the factors promoting the recurrence of tumors after carcinologic surgery and the potential possibilities of protection associated with the type of anaesthesia chosen

Émulsions lipidiques intraveineuses et toxicité systémique des anesthésiques locaux : mécanismes et limites [Intravenous lipid emulsion and local anesthetic-induced systemic toxicity: mechanisms and limits].

National audienc

Anaesth Crit Care Pain Med

INTRODUCTION: Dynamic arterial elastance (Eadyn) is defined as the ratio between pulse pressure variations (PPV) and stroke volume variations (SVV). Eadyn has been proposed to predict an increase in mean arterial pressure (MAP) after volume expansion with conflicting results. The aim of the present study was to test the reliability of Eadyn in hypotensive patients (MAP\textless65mmHg) in the operating room (OR). PATIENTS AND METHODS: The study pooled data from 51 patients. They were included after the induction of anesthesia and before skin incision. Eadyn, MAP and stroke volume (FloTracTM, VigileoTM, Edwards-Lifesciences, Irvine,CA) were recorded before and after volume expansion (500ml starch 6% given over 10minutes). Pressure-responders were defined as an increase MAP≥15% after volume expansion. Changes in MAP were predicted using the area under the curves (AUC) with their 95%Confidence Interval(95%CI) derived from Receiver Operating Characteristic curves. RESULTS: Seventeen patients responded to volume expansion. Heart rate, PPV, SVV and Eadyn were similar between pressure responders and non-responders. Baseline values of stroke volume, cardiac output and MAP were lower in responders. Volume expansion induced significant variations in stroke volume, cardiac output, SVV and PPV, but not in Eadyn. Baseline Eadyn failed to predict MAP increase (AUC=0.53,95%CI=0.36-0.70,P\textgreater0.05) and was not correlated with volume expansion-induced changes in MAP (P\textgreater0.05). In preload responsive patients (changes in SV≥15% after volume expansion,n=24), the AUC was 0.54(95%CI=0.29-0.78;P\textgreater0.05). CONCLUSION:In the present study performed in the OR and in hypotensive patients, Eadyn obtained using arterial signal was unable to predict an increase in MAP after volume expansion