Effects of neoadjuvant chemotherapy on the depth of total intravenous anesthesia in patients with breast cancer undergoing unilateral modified radical mastectomy

Abstract

Toxic effects of neoadjuvant chemotherapy (NC) on nervous, hepatorenal, and pulmonary systems might affect general anesthesia depth. This study aimed to evaluate the effects of NC on depth of total intravenous anesthesia.This prospective observational study enrolled 60 patients undergoing elective unilateral modified radical mastectomy during total intravenous anesthesia with propofol and remifentanil (January–June 2015; Liaocheng People's Hospital, China): the NC group (n = 30) received NC, while the control group (n = 30) did not. Propofol and remifentanil dosages were adjusted according to indexes of consciousness (IoC1: sedation; IoC2: analgesia) to control fluctuations of blood pressure and heart rate within 20% of baseline values. Parameters reflecting propofol/remifentanil dosages, intraoperative adverse events, and quality of anesthetic recovery were recorded.The duration of propofol infusion (1.3 ± 0.4 vs 1.8 ± 0.5 hours, P < .05), mean propofol dosage (8.0 ± 1.0 vs 9.3 ± 1.5 mg kg−1 h−1, P < .05), and adjustment frequency of target-controlled remifentanil infusion (2.9 ± 1.8 vs 4.4 ± 2.6 times/surgery, P < .05) were significantly lower in the NC group than in the control group; adjustment frequency of target-controlled propofol infusion was also numerically lower (2.0 ± 1.1 vs 2.7 ± 1.5 times/surgery, P = .053). Duration of remifentanil infusion, mean remifentanil dosage, voluntary eye opening, extubation time, and recovery score were not significantly different between groups. The incidence of tachycardia was lower in the NC group than in the control group (7.1% vs 37.0%, P < .05), but there was no significant difference in the incidence of total adverse events between groups.NC can enhance the sensitivity of breast cancer patients to the anesthetic effect of propofol.

A randomised trial: effects of different anesthesia methods on early perioperative pain sensitivity and cellular immune function in patients undergoing radical mastectomy

“…In recent years, the incidence of breast cancer has been on the rise (10). According to reports, breast cancer accounts for 7-10% of systemic malignant tumors, and is the most common tumor among females (10).…”

“…In recent years, the incidence of breast cancer has been on the rise (10). According to reports, breast cancer accounts for 7-10% of systemic malignant tumors, and is the most common tumor among females (10). Surgery is an effective means of treatment, but it is traumatic, the operation area involves extensive nerves, and the movement of the shoulder joint is limited after surgery (11).…”

“…General anesthesia is a commonly used in radical mastectomy for breast cancer, but it cannot completely block the conduction of peripheral stimulation to the central nervous system. Additionally, the large amount of anesthetics used in the operation can cause symptoms, such as respiratory de pression, nausea and vomiting, and an adverse prognosis (13,14). With the continuous improvement of anesthesia technology, TTP-PECS block is gradually being applied in clinical practice.…”

Effect of chemotherapy on effect-site concentration of propofol for loss of consciousness in patients with colorectal cancer

“…In their study, compared with the control group, patients in the neoadjuvant chemotherapy group had significantly lower propofol infusion duration and mean propofol dose required until loss of consciousness. [7].…”

A novel balanced anesthesia shortens time to emergence in patients undergoing modified radical mastectomy: a randomized prospective trial

“…Modified radical mastectomy, the most common treatment for patients suffering it, is generally performed under general anesthesia (1). Breast cancer exerts a considerable burden on both physical and mental health of the patients (2). Rapid emergence and smooth extubation can decrease the anxiety and restlessness by shortening the interval of separation from family members.…”