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Post by Wai-Ling Lo on Jul 31, 2021 11:03:44 GMT -5
1. Due to the data suggesting that volatile agents and opioids may cause immunosuppression, are you currently implementing TIVA with propofol/regional and ERAS techniques in the oncology population? I do TIVA for other reasons like smooth wakeup and prevention of PONV. As stated in the article, more research is needed to confirm the above finding. I will wait for more supportive results before I change my practice.
2. Do you currently use COX-2 inhibitors on a regular basis when taking care of oncology patients? Why or why not? I use COX-2 only when there is no potential contraindication and surgical team is ok with it.
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nanci
Junior Member
Posts: 57
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Post by nanci on Jul 31, 2021 15:35:52 GMT -5
1. Due to the data suggesting that volatile agents and opioids may cause immunosuppression, are you currently implementing TIVA with propofol/regional and ERAS techniques in the oncology population? As part of the Colorectal ERAS group I have used TIVA quite extensively over the past years with oncology patients. Adding regional techniques to spare opioid use appear to benefit the patient with good pain control in the recovery room (QL or TAP blocks for the robotic cases, Epidural for the open procedures, Pec blocks for the breast cases...).
2) Do you currently use COX-2 inhibitors on a regular basis when taking care of oncology patients? Why or why not? I seem to use the COX-2 inhibitors on a regular basis with the Colorectal cases for the reduced inflammation, pain reliever properties and a profile of reduced incidence of gastrointestinal ulceration and no inhibitory effect on platelet function. Usually used in conjunction with other ERAS protocoled medications. The ERAS teams have written out easy to follow protocol with links to rationale and evidence based studies- although not sure how often those are updated. Have not used them in other oncologic cases on a routine basis for various reasons- the primary being timely communication with the surgeon while patient still in the prep area. If best practices included it in more ERAS protocolized procedures I would most likely use them more keeping regard to renal effects in mind.
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Post by mary clothier on Jul 31, 2021 22:06:14 GMT -5
1. Great article on using TIVA for oncology patients to decrease any additional immunosuppression in our already compromised Cancer patient population! I will include this in my practice when caring for Ca patients.
2. I do not use cox-2 inhibitors, if research continues to supports their benefit, and statistical significance, of course they should be included.
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