paper i have res

Paper and critical appraisam

A paper I found particularly interesting was the GA-CARES trial published in Anesthesiology. For several years there had been considerable interest in whether propofol-based TIVA improved long-term cancer outcomes because of laboratory evidence suggesting better preservation of immune function compared with volatile agents. This study was a large pragmatic multicentre randomised controlled trial involving over 1,700 patients undergoing major cancer resections. Patients were randomised to propofol or volatile maintenance, with overall survival as the primary outcome. The study found no improvement in overall or disease-free survival with propofol. I felt the strengths were its randomised design, pragmatic methodology and clinically relevant endpoint. Limitations included the inability to blind anaesthetists and the inclusion of only selected cancer types. The paper is important because it challenges a widely held assumption based largely on retrospective data. It has reinforced my practice of selecting TIVA or volatile anaesthesia based on patient and surgical factors rather than expecting one technique to improve long-term cancer outcomes.”

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