Ventajas y desventajas de la técnica de anestesia balanceada Vs. la anestesia total intravenosa -TIVA- en el pronóstico de la cirugía de cáncer frente a la recaída
Palabras clave:
Anestesia Total Intravenosa (TIVA), anestésicos intravenosos, anestesia balanceada, cáncer, recaída.Resumen
Durante esta revisión se mostrarán las especificaciones de porque la técnica TIVA es la mejor opción en los pacientes con enfermedades metástasis por cáncer e incluso en estadios incipientes ya que a pesar de que el tratamiento quirúrgico es capaz hoy en día de extirpar totalmente el tumor primario y conseguir una citorreducción macroscópica completa, el 90 % de las muertes relacionadas con el cáncer son debidas a las metástasis y no al tumor primario. De esta forma la cirugía oncológica logra reducir la diseminación del mismo e incluso induce un estado posoperatorio de inmunosupresión, el cual se ha convertido en un gran reto para el anestesiologo, ya que este estado permite la micromestatasis y recaída del paciente oncológico.
Actualmente se incluye un importante avance y es la anestesia total intravenosa, la cual involucra la inducción y el mantenimiento de la anestesia sólo con fármacos intravenosos asociados a oxígeno suplementario, originando que los distintos
componentes del estado anestésico se controlen por separado: la hipnosis puede
ser provocada con múltiples agentes (Barbitúricos, benzodiacepinas, etomidato, o
propofol), destacando por sus propiedades farmacocinéticas el propofol. La analgesia
queda a cargo de los opioides potentes del grupo fenilpiperidinas, siendo el prototipo
remifentanyl por su atractivo perfil l farmacológico (18).
Citas
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