Anestesia no paciente oncológico

as técnicas e agentes anestésicos podem influenciar o desfecho destes pacientes? Uma revisão narrativa

Palavras-chave: Anestesia, Neoplasias, Recidiva, Câncer

Resumo

Introdução: A anestesia no paciente oncológico representa um desafio sob vários aspectos: pacientes complexos, com diversas comorbidades e, muitas vezes, submetidos a tratamentos adjuvantes. O tratamento cirúrgico é o tratamento de primeira linha em grande parte dos casos oncológicos e a anestesia é uma etapa essencial para viabilizar este tratamento. O uso de diferentes agentes e técnicas anestésicas hoje é visto como um dos potenciais fatores que podem vir a influenciar o desfecho oncológico. Revisamos alguns dos novos conceitos que têm surgido na literatura, referentes aos cuidados anestésicos perioperatórios e a evolução desta população. Métodos: Estudo bibliográfico narrativo e exploratório. Realizada pesquisa nos bancos de dados Medline e SciELO, utilizando os termos (((anesthesia) OR (anaesthesia)) AND (cancer)) até novembro de 2019 e 44 estudos foram utilizados. Resultados: Os estudos discutem o papel específico de diversos agentes anestésicos, principalmente agentes hipnóticos endovenosos, inalatórios e opioides, além de abordarem as possíveis diferenças entre as técnicas anestésicas. Além dos agentes anestésicos propriamente ditos, o papel de outros agentes frequentemente utilizados no período perioperatório foram incluídos. Conclusões: Técnicas de anestesia regional ainda necessitam ser mais estudadas, mas podem trazer benefícios para esta população auxiliando no controle álgico perioperatório, reduzindo o consumo de opioides e a inflamação desencadeada pela resposta ao estresse. Ainda não há evidências suficientes para modificação dos agentes e técnicas utilizadas na anestesia, mas existem alguns potenciais benefícios sinalizados para o uso de anestesia venosa, técnicas de analgesia multimodal poupadora de opioides e, até mesmo, o uso de certos agentes como a lidocaína e o propofol. Poucas evidências clínicas respaldam o uso de anestesia totalmente livre de opioides com o objetivo de reduzir a recorrência tumoral e otimizar o desfecho do paciente oncológico, mas o assunto está sendo amplamente pesquisado e brevemente haverá mais novidades e evidências que poderão redirecionar a conduta anestésica perioperatória.

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Biografia do Autor

Felipe Porto Rangel, Instituto do Câncer do Estado de São Paulo (ICESP)

Médico anestesiologista do Instituto do Câncer do Estado de São Paulo - ICESP, pós-graduando do programa de Anestesiologia, Ciências Cirúrgicas e Medicina Perioperatória da Faculdade de Medicina da Universidade de São Paulo. 

José Otávio Costa Auler Junior, Instituto do Câncer do Estado de São Paulo (ICESP). Faculdade de Medicina FMUSP da Universidade de São Paulo

Prof. Titular da Disciplina de Anestesiologia da Faculdade de Medicina FMUSP da Universidade de São Paulo. Instituto do Câncer do Estado de São Paulo (ICESP).

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Publicado
2020-02-03
Como Citar
Rangel, F., Simões, C., & Auler Junior, J. O. (2020). Anestesia no paciente oncológico. Revista De Medicina, 99(1), 40-45. https://doi.org/10.11606/issn.1679-9836.v99i1p40-45
Seção
Artigos de Revisão/Review Articles