General anaesthesia versus other types of anaesthesia in patients undergoing surgery for treatment of cutaneous melanoma: a systematic review and meta-analysis

Araujo, Bruno Luís de Castro; Oliveira, Jadivan Leite de; Corrêa, Flávia de Miranda; Fontes, Luis Eduardo Santos; Melo, Andréia Cristina de; Thuler, Luiz Cláudio Santos

doi:10.1684/ejd.2021.4109

Cited by 3 publications

(5 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a recent systematic review, Araujo et al compared general anesthesia with other types of anesthesia in surgical procedures for the treatment of malignant melanoma and developed a conceptual framework of potential benefits for choosing regional anesthesia 2 . The elimination of inhalational anesthetics and high-dose opioids, associated with the use of regional anesthesia in appropriate concentrations, may improve early and late clinical outcomes and reduce costs in this population 2 . Additionally, there have been recommendations to avoid general anesthesia during the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Serratus plane block with sedation for patients submitted to axillary dissection: a prospective case series

Theobald

Araujo

Thuler

et al. 2023

Rev. Col. Bras. Cir.

Self Cite

View full text Add to dashboard Cite

Axillary dissection is a standard surgical procedure for stage III skin and soft tissue tumors and is usually performed under general anesthesia. This study aimed to investigate the feasibility of performing axillary dissection with Serratus muscle plane block plus intravenous sedation. Fifteen patients undergoing axillary dissection were prospectively recruited. The patients were evaluated during their pre-operative anesthetic appointment, during their procedure, and at post-operative days 1 and 30. The blockade was performed superficial to the Serratus muscle at the level of fourth rib. Sedation was performed using propofol, fentanyl, dexmedetomidine, and S-ketamine. None of the patients required conversion to general anesthesia. Surgeons showed a highly positive response when asked about the anesthetic technique, and most of them found the technique “indistinguishable” from general anesthesia. The median (interquartile range) pain scores at rest over all time frames was 0 (0-0). Furthermore, no patients developed nausea, hemodynamic instability, or any complications associated with the technique. The Serratus plane block associated with intravenous sedation proved feasible for axillary lymphadenectomy, however, further clinical trials should evaluate potential advantages compared to other techniques.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Patients undergoing it are at high risk of postoperative and chronic pain, shoulder functional limitation, and lymphedema, leading to impaired health-related quality of life 1 . Previous studies have evaluated the feasibility of tumescent local anesthesia with sedation for patients undergoing axillary dissection 2 .…”

Section: Introductionmentioning

confidence: 99%

Serratus plane block with sedation for patients submitted to axillary dissection: a prospective case series

Theobald

Araujo

Thuler

et al. 2023

Rev. Col. Bras. Cir.

Self Cite

View full text Add to dashboard Cite

show abstract

“…Os pacientes submetidos a esses procedimentos têm alto risco de dor pós-operatória e crônica, limitação funcional do ombro e linfedema, levando a comprometimento da qualidade de vida relacionada à saúde 1 . Estudos anteriores avaliaram a viabilidade de técnicas de anestesia local tumescente com sedação para pacientes submetidos à dissecção axilar 2 . Desde a descrição do Bloqueio do Plano do músculo Serrátil anterior (BPS) guiado por ultrassonografia na última década por Blanco et al, houve um grande interesse no potencial desse bloqueio mudando desfechos como consumo de opioides e dor pós-operatória 3 .…”

Section: Introductionunclassified

Bloqueio do plano do músculo serrátil guiado por ultrassonografia associado à sedação venosa como técnica anestésica em cirurgia de linfadenectomia axilar: uma série de casos prospectiva

Theobald

Araujo

Thuler

et al. 2023

Rev. Col. Bras. Cir.

Self Cite

View full text Add to dashboard Cite

RESUMO A linfadenectomia axilar é um procedimento cirúrgico padrão para tratamento de tumores de pele e partes moles no estádio III e usualmente é realizada sob anestesia geral. A presente serie de casos prospectiva tem por objetivo investigar a viabilidade da realização da linfadenectomia axilar com o uso do bloqueio do plano do músculo serrátil anterior associado a sedação endovenosa. Foram incluídos 15 pacientes no estudo. Os participantes foram recrutados e avaliados durante consulta pré-anestésica ambulatorial, acompanhados durante o dia da cirurgia, no primeiro e no trigésimo dias de pós-operatório. O bloqueio foi realizado anterior ao músculo serrátil anterior ao nível da quarta costela na linha axilar média. A sedação foi realizada com o uso de propofol, fentanil, dexmedetomidina e dextrocetamina. Não houve necessidade de conversão para anestesia geral em nenhum paciente. Os cirurgiões apresentaram resposta altamente positiva quando questionados sobre a técnica anestésica, considerando na maior parte dos casos “indistinguível” da anestesia geral. A mediana (intervalo interquartil) da dor em repouso em todos os momentos avaliados foi 0 (0-0). Além disso, nenhum paciente desenvolveu náuseas, vômitos, instabilidade hemodinâmica ou qualquer complicação relacionada à técnica empregada. O bloqueio do plano do músculo Serrátil anterior associado a sedação venosa se mostrou viável para execução de linfadenectomia axilar, entretanto ensaios clínicos adicionais são necessários para avaliar potenciais vantagens em comparação com outras técnicas.

show abstract

“…While immune modulation is important for systemic therapy, the impact of immune modulation on the surgical treatment and use of anesthesia in cutaneous melanoma is less well understood. A meta-analysis in 2019 of eight studies including 5832 patients showed that the use of general anesthesia was not associated with any difference in overall or disease-free survival, but melanoma-specific survival was worse across three studies that incorporated this metric (hazard ratio 1.46, 95% confidence interval 1.22–1.68) [58]. Of these three studies, significance was only found in the largest study by Schalgenhauff et al ., which contributed 71.6% of the analysis weight [58,59].…”

Section: Introductionmentioning

confidence: 99%

“…A meta-analysis in 2019 of eight studies including 5832 patients showed that the use of general anesthesia was not associated with any difference in overall or disease-free survival, but melanoma-specific survival was worse across three studies that incorporated this metric (hazard ratio 1.46, 95% confidence interval 1.22–1.68) [58]. Of these three studies, significance was only found in the largest study by Schalgenhauff et al ., which contributed 71.6% of the analysis weight [58,59]. In this work, the authors examined 4329 patients from the Central Melanoma Registry of the German Dermatological Society with primary cutaneous melanoma who underwent surgical excision with either local or general anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Impact of anesthesia choice in cutaneous melanoma surgery

Benesch,

Skitzki

2023

Melanoma Research

View full text Add to dashboard Cite

Invasive cutaneous melanoma is the most lethal skin cancer, but fortunately, the vast majority can be surgically treated with wide local excision, and sometimes additionally with sentinel or index lymph node biopsy for prognostication. Melanomas are particularly immunogenic malignancies, and preclinical studies have demonstrated that use of volatile anesthetics and opioids, unlike local agents, can suppress the immune system during the perioperative period. Immunosuppression has implications for creating a potentially favorable microenvironment for the survival and propagation of residual melanoma cells or micro-metastases, which could lead to disease relapse, both in the local tumor bed and distally. Results from observational clinical studies are mixed, but the literature would suggest that patients are at risk of decreased melanoma-specific survival after undergoing general anesthesia compared to regional anesthesia and spinal blocks. With the safety of close observation now established rather than automatic completion or total lymph node dissection for patients with either a positive sentinel lymph node biopsy or significant clinical response to neoadjuvant immunotherapy after index node sampling, the indications for definitive surgery with local or regional anesthesia have increased tremendously in recent years. Therefore, cutaneous melanoma patients might benefit from avoidance of general anesthesia and other perioperative drugs that suppress cell-mediated immunity if the option to circumvent systemic anesthesia agents is feasible.

show abstract

General anaesthesia versus other types of anaesthesia in patients undergoing surgery for treatment of cutaneous melanoma: a systematic review and meta-analysis

Cited by 3 publications

References 41 publications

Serratus plane block with sedation for patients submitted to axillary dissection: a prospective case series

Serratus plane block with sedation for patients submitted to axillary dissection: a prospective case series

Bloqueio do plano do músculo serrátil guiado por ultrassonografia associado à sedação venosa como técnica anestésica em cirurgia de linfadenectomia axilar: uma série de casos prospectiva

Impact of anesthesia choice in cutaneous melanoma surgery

Contact Info

Product

Resources

About