Anaesthesia for Primary Bone Sarcoma

Question 1

Typical Radiological Scans for Sarcoma Surgery

Answer 1

• CT Chest
• Whole body CT PET
• Whole body MRI

Question 2

Types of Sarcoma

Answer 2

• Osteosarcoma
• Chondrosarcoma
• Ewing’s Sarcoma
• Chordoma- grows on remanents of the notochord in the skull base and sacrum
• Spindle cell sarcoma
• Angiosarcoma

Question 3

Common locations for sarcoma

Answer 3

• Lower limb
• Pelvis
• Upper limb

Question 4

Considerations after neo-adjuvant therapy and before surgery

Answer 4

• FBC- neutrophils >1, plts and clotting suitable for regional anaesthesia?
• Recent ECHO - Vincristine/ Doxurubicin
• Renal function- esp if cisplatin is used
• Nutritional status
• Recent group and save- possible antibody formation
• Evidence of peripheral neuropathy
• Recent radiotherapy?
• Recent immunotherapy?

Question 5

Minimise blood loss in sarcoma surgery by…

Answer 5

Pre-operative embolisation in IR of highly vascular osseous tumours

Question 6

Reasons to use TIVA for sarcoma resection surgery

Answer 6

• Propofol possibly supports NK cell function and destroys micro-metastases
• Reduced PONV
• Preserves motor evoked potentials if monitoring required