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Co-existing Test 1 > Anesthesia and Cancer > Flashcards

Anesthesia and Cancer Flashcards

1
Q

What does cancer result from?

A
  • Accumulation of genetic mutations that causes dysregulation of cellular proliferation (alteration in DNA structure)
    • inherited traits
    • mutaiton of normal gene into an oncogene
    • inactivation of tumor suppressor gene (p53)
  • Fundamental cellular event in malignancy: alteration in DNA structure
  • immune surveillance destroys many malignant cells
    • HIV/immunosuppressant disrupt protective mechanism
  • Most cancers produce solid tumors
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2
Q

What does TNM stand for?

A

tumor

nodes

metastatic disease

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3
Q

What carincogens are estimated to be responsible for 80% of cancers in the United States?

A
  • Tobacco
  • alcohol
  • sunlight
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4
Q

Most common cancers?

A
  • Prostate (men), breast (women)
  • lung #2 in both male/female (leading cause of death)
  • Colon Ca 2nd leading cause of death
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5
Q

What are some pathological changes in the hematologic system with cancer?

A
  • Anemia
    • bone marrow suppression
    • GI ulceration and anemia due to invasion
  • Neutropenia- decrease WBC
  • Thrombocytopenia
  • hypercoagulable state; risk of thromboembolic events
  • Hypercalcemia
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6
Q

Pathological effects of cancer on neuromuscular system?

A
  • myofascial pain and peripheral neuropathies
  • spinal cord compression
  • metastatic brain tumors, most often from lung and breast Ca
  • presents usually as mental deterioration, focal neurologic deficits or seizures
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7
Q

Pathologic changes in pulmonary system during cancer?

A
  • Pulmonary edema/CHF
  • Recurrent pleural effusions
  • pneumonitis
  • Lung Ca specifically
    • squamous cell (25-40%)–> hypercalcemia
    • adenocarcinoma (30-50%)–> hypercoagulable/osteoarthritis
    • large cell (10%)–> gynecomastia
    • small cell (15-24%)–> inappropriate ADH secretion/ectopic corticotropin secretion
      • eaton-lambert
      • myasthenice syndrome
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8
Q

What is pulmonary osteoarthropathy?

A

Pulmonary osteoarthropathy- condition that affects some lung Ca pt-clubbing, spoon shaped nails, inflammation/swelling/pain in hands, fingers, knees ankles

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9
Q

What are some other various pathological changes that can occur system wide?

A
  • Anorexia/weight loss- hyperalimentation
  • electrolyte abnormalities
    • hypercalcemia d/t bone mets
    • Na and K changes with N/V/D
  • Adrenal insufficiency- tumor or suppression of adrenals with corticosteroid rx
  • ectopic hormone production (specific small cell LC)
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10
Q

What are some pathological changes from cancer in cardiac system?

A
  • Malignant involvemnt of pericardium (pericardial effusion)
    • electric alternans or paroxysmal a fib
    • pericarial tamponade
      • most common with lung Ca
    • Drug induced CMP
      • impariment of LVF for as long as 3 years after d/c of therapy
  • SVC Obstruction
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11
Q

What is SVC obstruction? What causes it?

A

Metastatic spread to mediastinum

  • venous engorgment above the waist, dyspnea and airway obstruction
  • increased ICP from increase in CVP
  • Compression of great vessels may lead ot syncope
  • hoarseness/dyspnea may indicate tracheal compression
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12
Q

Concerns with mediatsinal masses?

S/S of concerning mediatsinal mass?

A
  • Always perserve spontaneous respiration
  • never induce general anesthesia
    • sometimes the only thing keeping the airway open is the patient spontaneously breathing
    • if need general anesthesia- need bypass on standby

S/S of concerning mediastinal mass

  • JVD
  • irritable
  • nausea
  • hoarseness
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13
Q

Pathological changes in renal system with cancer

A
  • decreased clearance
  • drug induced nephrotoxicity/nephrotic syndrome
  • ureteral obstruciton>> hydronephrosis
  • hyperuricemia
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14
Q

Pathologic hepatic system effects from cancer?

A
  • Damage to hepatocytes
  • coagulopathies
  • DIC common with hepatic metastasis - poor prognosis
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15
Q

Metabolic complications with cancer?

A
  • Catabolic state- cancer burns through energy
    • diarrhea
    • poor nutritional status- chekc albumin
    • volume depleted state
      • hypotension
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16
Q

What are paraneoplastic syndromes?

A
  • Affects 8% of pt with cancer
    • some come in as emergency. 80% occur before dx of ca
  • Fever/cachexia
  • neuro abnormalities: limbic encephalitis, cerebellar degeneration, lambert-eaton myasthenia syndrome and myasthenia gravis
  • endocrine adnormalities: SIADH, Hyper calcemia, cushing syndrome, hypoglycemia
  • Renal abnormallities: nephritis, amyloidosis
  • derm abnorm.
  • rheumatologic abnormalities
  • hema abnormlalites
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17
Q

What is Lambert Eaton syndrome?

A
  • antibodies develop to voltage-gated calcium channel receptors
    • commonly associated with SCLC
  • Can cause NMB sensitivity and major potentiation
    • not frequently dx, usually will be recognized when administered anesthesia
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18
Q

How is cancer treated?

A

Multimodal therapy is most common

  • Surgery
  • traditional chemo: various MOA
  • Targeted chemo: monoclonal antibodies
  • radiation therapy: MOA is damage to DNA
  • Ablation therapy
    • RFA: primary liver tumors and metastases, localized lung, kidney, adrenal gland, and bone tumors
  • Cancer vaccines and immunomodulators
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19
Q

MOA Alkylating agents?

A

Form reactive molecules that cause DNA cross-linking problems such as abnormal base pairing and strand breaks that interfere with primarily with DNA but also RNA, protein synthesis and replication

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20
Q

MOA antimetabolites?

A

Structural analogs of folic acid, purines, or pyrimidines that block enzymes necessary for nucleic acid and protein synthesis

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21
Q

MOA antitumor antibiotics?

A

form complexes with DNA/RNA that inhibit their subsequent synthesis

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22
Q

MOA Microtubule assembly inhibitors?

A

vinca alkaloids and taxanes, both of which act on the mitotic process by interfering wiht microtubulea ssembly or diassembly

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23
Q

Adverse effects of Ca treatment?

A
  • bone marrow suppression
  • cv toxicity
  • pulmonary toxicity
  • central and peripheral nervous system damage
  • renal toxicity
  • hepatic toxicity
  • gi/endocrine changes
  • other: mucositis, ototoxicity, renal insuff.
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24
Q

Chemo drugs associsted with CV toxicity?

A

Class: anthracyclines- most commonly associated

Ex: Doxorubicin (adriamycin) & daunorubicin

  • dose-related CMP
  • Can be acute/chornic
    • acut CMP 10% (benign and symptoms usually resolve with d/c
      • dysrhythmia, QT prolongation
  • Chronic toxicity- LV dysfunction and CMP can occur in an early onset form taht usually appears within 1 yr of treatment and a late-onset form that can emerge much later
  • Enhances myocardial depression with anesthetics (acute LV failure during GA, 1 mo after cessation)

PEARLS- BASELINE and periodic ECHO recommended

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25
Q

What are some cardiac affects with fluorouracil?

A

Associated with pericarditis, angina, coronary artery vasospasm, ichemia-related EKG changes, and conduction defects

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26
Q

What are some side effects of monoclonal antibodies?

A

high level HTN

Bevacizumab, trastuzumab, sorafenib (all exampled monoclonal antibodies)

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27
Q

Cardiac s/e of radiation to chest?

A
  • Myocardial fibrosis
  • pericarditis
  • valvular fibrosis
  • conduciton abnormalities
  • accelerated development of CAD
  • Cumulative exposure is a factor
    • ALSO can see these effects if patient had radiation has child but is perfectly healthy now
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28
Q

What are some anesthesia implications for bleomycin?

A

Bleomycin has dose-related toxicity

  • causes endothelial damage (looks like PNA)–> type I and type II alveolar necrosis–> pulmonary fibrosis- no Rx
  • pulmonary HTN
  • Increased A-a gradient
  • induced hyperoxic pulmonary injury- free radical formation
  • Recommend
    • baseline and serial PFT and CXR
    • ABG Sao2
    • adjust o2 for sat >90%
    • colloid v crystalloid (don’t want to overhydrate with cyrstalloid)
    • corticosteroids
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29
Q

What are other drugs that can cause pulmonary toxicity?

A
  • Cyclophosphamide
  • busulfan
  • methotrexate
  • lomustine
  • carmustine
  • mitomycin
  • vinca alkaloids
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30
Q

Concerns with methotrexate?

A
  • Fulminant non-cardiogenic pulmonary edema
  • progressive inflammation with infiltrates and effusions
  • toxicity 8%
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31
Q

What are some pulmonary effects with radiation to chest?

A
  • interstitial pneumonities and pulmonary fibrosis
  • tracheal stenosis
    • airway exam can be completely normal
    • smallest tube possible
      • if you can’t pass, maybe need to wake up
  • Symptoms typically begin within first 2-3 months of treatment and usually regresses within 12 months
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32
Q

“Pearls” for pulmonary toxicity

A
  • Preop o2 sat, CXR, PFT, ABG
  • Intraop exposure to high concentraiton o2 may exacerbate preexisting bleomycin induced lung injury and contribute to postop vent failure
  • periop coritcosteroid admin may be of benefit in treating bleomycin-induced pneumonitis
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33
Q

What are some renal effects from cisplatin?

A
  • decreased GFR within 3-5 days
  • renal insufficiency and hypomagnesemia are typical presenting signs
  • ATN–> ARF–> HD
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34
Q

What are renal symptoms with methotrexate (antimetabolite)

A
  • usually ok as long as pt gets Leucovorin, prehydraiton and avoidance of other nephrotoxic drugs
  • these intervention reduce incidence of renal toxicity
35
Q

Cyclophosphamide renal issues?

A

Associated with SIADH

Hemorrhaic cystitis–> can be severe and cause obstructive nephropathy and ARF

36
Q

Ifosfamide renal issues?

A

Proximal tubule dysfunction marked by proteinuria and glucosuria

37
Q

What are some renal issues with induction chemo and high-dose radiation?

A
  • Induces tumor cell lysis that causes release of large amounts of uric acid, phosphate and potassium, especially with large tumor burden (ie hematologic)
  • hyperuricemia can cause uric acid crystals to precipitate in renal tubules, leading to ARF
  • Can caues glomerulonephritis or glomerulosclerosis with permanent injury marked by chornic renal insufficiency and systemic HTN
  • Life threatening hyperkalemia can occur
  • hyperphosphatemia leads to hypocalcemia and can increase likelihood for dysrhthmia

PEARLS: NEET ELECTOLYTES BEFORE SLEEP

BUN/CR, URINE ANALYSIS

38
Q

What is a chemo drug associated with liver dysfunction?

What syndrome can TBI cause in the liver?

A

Methotrexate

  • associated with acute liver dysfunction

Radiation is associated with sinusoidal obstruction syndrome

  • severe liver dysfunction with high mortality
    • very sick, fulminate liver failure
    • cirrhosis acutely
39
Q

What is association of mucositis and cancer?

A
  • from high-dose chemo and radiation
  • patients with mucositis are at risk of infection from spread of oral bacteria
  • narcotics frequently required. psudomembrane formation, edema and bleeding may cause airway compromise or risk of aspiration
40
Q

What should we be concerned about when someone’s had radiation to head/neck?

A
  • Permanent tissue fibrosis
    • limited mouth opening
    • lmited neck ROM
      • may need video laryngo and airway cart
    • limited tongue mobility
    • trahceal stenosis: unrecognized on physical exam
  • PEARLS
    • preop airway assessment, cervical ROM x ray, ENT consult
      • when in doubt, ENT consult!
41
Q

What are some GI/endocrine changes with cancer treatments?

A
  • N/V/D, enteritis are common after chem + radiation
    • results in dehydration, electrolyte abnormalities and malnutrition
  • Radiation to abd may produce permanent adhesions and stenotic lesions along GI tract
  • hyperglycemia from steroid therapy
  • SIADH seen with cyclophosphamide, ifosfamide, cisplatin or, from tumor itself
  • Radiation to neck or TBI may cause hypothyroidism or panhypopituitarism
  • Preop thyroid function tests, CMP, BG, urine specific gravity
42
Q

What are some hematologic system changes with chemo or radiation?

A

Chemo

  • myelosuppression
    • chemo’s job is to get rid of cells that are rapidly turning over. can’t discriminate b/w RBC or own cells that are replicating
  • thrombocytopenia and/or platelet dysfunction
  • tumors release procoagulants that create hypercoagulable state
    • VTE prophylaxis is essential in high risk pt

Radiaiton

  • coagulation necrosis of vascular endothelium
    • blood vessel can die
    • sometimes with radiation, brain tumor is bleeding more and can cause pt to deteriorate until tumor starts to necrose
  • post-radiation bleeding

GET CBC PT/PTT/INR preop

43
Q

What nervous system changes can high dose cyclophosphamid cause?

A
  • acute delirium
  • encephalopathy
  • ataxia
44
Q

What nervous system changes can methotrexate cause

?

A

dementia

45
Q

What nervous system changes can Vinca Alkaloids (Vincrinstine) cause?>

A
  • Sensorimotor peripheral neuropathy- paresthesia in hands/feet
  • Autonomic neuropathy- usually reversible (dysautonomia–> hypotension)
  • Cuation with regional anehesia: sublinical neurotoxicity may be present

Cisplatin- dose dependent damage to dorsal root ganglia–> large fiber neuropathy

46
Q

What nervous system changes do alkylating agents cause (Cytoxan= cyclophosphamide)

A
  • Plasma cholinesterase inhibition
    • prolongs effects of succinylcholine by reducint available plasma cholinesterase enzyme to metabolize the drug
47
Q

General anesthesia considerations with cancer?

A
  • Correction of nutrient deficiencies, electrolyte abnormaliites, anemia, and coags
    • sometimes will tolerate lower Hgb to minimize transfusions
  • Labc: cbc, coag, LFT, serum electrolytes
  • Test: CXR ,echo, PFT, o2 sat, VS
48
Q

What are anesthesia concerns with pt on Bevacizumab?

A

Surgery delayed 4-8 weeks post Bevacizumab r/t increased risk of bleeding an dpostop wound complications

49
Q

Anesthesia considerations with doxorubicin?

A

Doxorubicin- cardiac toxic, cmp, arrhythmia

Wathc EKG- some chemo agnest cause arrhythmias

50
Q

Anesthesia considerations with belomycin?

A
  • Pulmonary fibrosis
  • ABG o2 sat
  • carefully titrate IV fluid replacement d/t risk of developing interstitial pulmonary edema r/t impaired lymphatic drainage in lungs
  • use colloid vs crystalloid
  • avoid high concentration o2
    • o2 sat >90 and fio2 <30
51
Q

What are some anesthesia considerations with methotrexate?

A

Avoid n2o, augments toxicities

52
Q

Which anesthesia med is not a good choice for Cyclpophosphamide’s?

A

Succinylcholine- may have prolonged response (drug-induced pseudocholinesterase deficiency)

53
Q

What do you need to watch for with administration of muscle relaxants to patient’s recieving chemo/radiation treatment?

A

Paraneoplastic syndromes like eaton lambert

54
Q

When a patient has been on steroid therapy, what is the lenght of time when you should be concerned for adrenal suppression?

What would be a treatment?

A

20 mg of prenisone for longer than 3 weeks

  • Can supplement adrenal suppression with 100mg IV hydrocortisone at induction with 100 mg q 8 hours for first 24 hours after surgery
55
Q

What are some recommendations for pain management in cancer patients?

A
  • Anesthetics and analgesic have immunomodulatory properities
    • regional is best
  • IV opioids tend to blunt NK cell activity
    • regional anesthesia preferred
    • however, watch coags. use multimodal treatment
    • must assess and doc baseline neuropathetis if regional concidered
  • may need increased requirements for analgesia
  • NSAIDs effective for bone pain
    • most common type of cancer pain
  • Opioid admin
  • Adjuncts: antidepressants, anticonvulsants, gabapentin, ketamine
  • Nerve blocks- neurolysis (with celiac plexus block with alchol/phenol)
    • goal is sensory destruction whiel sparing motor/autonomic function
  • Corticosteroids
    • decrease pain perception, have sparing effect on opioid requirement
    • improve mood, increase appetite, lead to weight gain
56
Q

What are considerations for managing nausea/vomiting in cancer patient

A
  • Treatment of nv
    • metoclopramide
    • droperidol- black box for antipsychotic range (qt prolongation)
    • zofran
    • cannabis
    • (also haloperidol, benadryl, ativan)
  • Patient will often verbalize a high degree of anxiety related to the potential for nausea and vomiting
  • must provide reassurance tha tmeasures will be taken to control nausea and vomiting
57
Q

What is involved in a cordotomy? Dorsal rhizotomy?

A
  • Cordotomy- interrupt the spinothalamic tract in the spinal cord and is considered for treatment of unilateral pain involving lower extremity, thorax, or UE
  • Dorsal rhizotomy- inovlved interruption of sensory nerve roots
    • used when pain is localized to speicifc dermatome levels
    • dorsal column stimulators ro deep brain stimulators may be used in selected patients
58
Q

Considerations with lung cancer and anesthesia?

A
  • Leading cause of cancer death
  • Presenting clincial signs- cough, hemoptysis, wheezing, stridor, dyspnea, or pneumonitis from airway obstruction
  • Mediastinal masses may cause hoarseness (recurrent laryngeal nerve compression), SVC syndrome, cardiac dysrhythmias, of CHF from pericardial effusion and tamponade?
  • Generalized weakenss, fatigue, anorexia, weight loss common
59
Q

Where do squarmous cell cancers originate? presenting signs?

A
  • Arise in major bronchi or their primary divisions
  • grow slowly and reach large size before detected
  • Hemoptysis, bronchial obstruction with associated atelectasis, dyspnea and fever from pneumonia are common presenting signs
60
Q

Where do adenocarcinomas of lung originate? Present signs?

A
  • Originate in lung periphery
  • Tumors commonly present as subpleural nodules
    • have tnedency to invade plera and induce pleural effusions
  • Difficult to differentiate morphologically
61
Q

Where do large cell carcinomas arise from?

A
  • Peripheral in origin and present as large, bulky tumors
  • metastasize early and preferentially to CNS
62
Q

Where do small cell carcinomas arise from? metastisize to?

A
  • Central bronchial origin and ahve high frequency of early lypmhatic invastion
    • epseically to lymph nodes in mediastinum, mets to liver, bone, CNS, adrenal glands and pancrease
  • SVC syndrom may result
  • Propensity to produce polypeptides and ectopic hormones that result in metabolic abnormalities
63
Q

Surgical procedures for lung cancer?

A
  • Diagnositc- flexible fiberoptic bronchoscopy
  • Fine-needle aspirations by fluoroscopy
  • VATS
    • bx, wedge rsection, lobectomy
  • Mediastinoscopy
    • lymph node bx
      • hemorrhage, and pneumothorax most frequent
    • Right innominate compression (aka, right brachiocephalic)
      • can lose pulse ox/art line waveform if compressed
      • put art line on R side so we know innominate is being compressed
  • Thoracotomy
    • complex, pneumonectomy
64
Q

Concerns for lung cancer surgery?

A
  • PFT essential : predicted postop pulmonary function is also assessed
    • in general, if prediced postop FEV1 <0.8L , patients are poor candidates for pneumonecrtomy
  • involvemnt of lung impacts ventilation
    • increased incidence of associated CAD
  • Pain- patient receiving txmt for cancer-releated pain may have up-regulated opioid receptors
  • Ectopic endocrine effects (small cell carcinoma)
    • 3% pt are cushinoid
    • 60% with lung Ca have inappropriate ADH (SIADH)
65
Q

Anesthesia management for diagnositc bronchoscopy?

A
  • Genral- TIVA, large ETT (at least 8/9)
  • MAC
  • Ultasound guided bronch takes longer and ETT is preferred
    • ebus- get bronch, send off to pathology and see if they got a good sample
66
Q

Anesthesia management for VATs case?

A
  • General
    • aline, fluid restriction, lateral position, single lung ventilation (doublt lumen ETT/ Bronchial blocker),
  • One lung ventilation
    • peep on up lung
    • cpap on down lung
    • Frequent ABGS
  • Pulmonary insufficienncy after lung tissue resection- plan ETT post op
  • Pneumothorax- chest tube
    • potential for masive blood loss during sx resection
    • thoracic epidural for post op pain managmenet- place prior ot induction
  • Hemorrhage possible
    • t &c, 2 large bore IV, check h&h intraop, blood warmer, 2 prbc in room with 2 on hold
  • Monitor UOP- because limiting fluid
  • Lateral position- V/Q mismatch, nerve injuries
67
Q

Anesthesia managmeent for mediastinoscopy?

A
  • General
    • ETT, controlled ventilation (concern, pneumo)
  • Tumor location? Compression trachea with NMB–> may need awake fiberoptic intubation for ETT
    • Scope–> pressure on R subclavian–> loss of pulse–> false dx arrst (Pulse ox L and A line R)
  • Stretch of vagus or trachea–> bradycardia
    • vocal cord problems
68
Q

Anesthesia management considerations for thoracotomy?

A
  • General
    • aline, central line, fluid restriction, lateral position, lung isolation, one-lung ventilation, thoracic epidural
  • One- lung ventilation
    • peep on up lung
    • cpap on down lung
  • Pulmonary insufficiency after lung tissue resection- plan ETT postop
  • Pneumothorax- chest tub
  • thoracic epidural for postop pain management- placed prior to induction
    • don’t dose until after induction
  • Hemorrhage possible
    • t& c, 2 large bore ivs, chekc h& h intraop, blood warmer
    • potential for massive blood loss during sx resection
  • Monitor UOP
  • Lateral position- V/Q mismatch, nerve injuries

Same consideration as VATS but experience a LOT more pain

69
Q

What type of double lumen tube do we usually use?

A

L double lumen tube. - typically lose ventilation RUL with R double lumen ETT

sized based on height

check placement on insertion with bronch and after patient moved laterally

70
Q

Concerns for breast cancer surgery?

A
  • Poor venous access- avoid IV on operative side if possible
  • Monitor placement- avoid BP cuff on operative side
  • Tamoxifen
    • increased risk of thomboembolic events
    • DVT
    • PE
    • Stroke
  • If on doxorubicin chemo- cardiotoxicity with CMP
  • If radiation therapy= pulmonary fibrosis
  • Isosulfan blue dye for LN mapping- associated with anaphylaxis 1%
    • transiently affects oximetry
  • If s in axillary n area- wont’ want NMB on board!!! choose short acting when putting to sleep
71
Q

Anesthesia management for various breast cancer surgeries?

Bx?

Lumpectomy?

Mastectomy?

Radical mastectomy/node dissection

A
  • Bx
    • local with sedation
    • general- after radiology with needle placement
  • Lumpectomy- GA
  • Mastectomy- GA
  • Radical mastectomy/node dissection- GA, ETT
72
Q

Procedures performed for colon/GI cancer sx?

A
  • Diagnostic- endoscopy
  • Laparoscopic
  • Laparotomy- radical surgical resection (blood vessels and lymph nodes)
73
Q

Anesthesia concerns for clon/GI cancer surgery?

A
  • Radiation
    • diarrhea
    • cystitis
  • Pain
    • pt receiving treatment for cance-rrelated pain may have upregualted receptors and need more drug
  • Bowel prep–> hypovolemic–> tachycardia/hypotension
  • Ascites–> low albumin level, and affect intrathoracic pressure
  • anemia
74
Q

Concerns with hipec surgery?

A
  • Sx- take out organs like whipple
  • high dose chemo instilled in abd for one hour
  • causes lots of tumor lysis and electolye disturbances
75
Q

Anesthesia management during endoscopy?

A
  • Sedation
  • GA- TIVA (propofol)<– if pt can’t respond to name, general anesthesia
    • natural airway- NC- 2/Chin lift
76
Q

Anesthesia concerns during laparoscopic procedures>

A
  • General ETT ?RSI?
  • Regional- epidural
  • Hypovolemia–> avoid drugs which cause hypotension and/or decrease doses
  • avoid N2O
  • Drugs that are protein bound –> lower doses if low protein lab value
  • anemia, lower MAC
  • Avoid metoclopramide wiht obstruciton - contraindication
77
Q

Anesthesia managment for laparotomy?

A
  • General? RSI? <– full stomach, opioid slowing stomach
  • Regional- epidrual
  • hypovolemia–> avoid drugs which cause hypotension
  • avoid n2o- distention of bowel
  • drugs that are protein bound–> lower doses if low protein
  • anemia, lower MAC
  • Avoid metoclopramide
  • laparotomy- muscle relaxation needed for retractors
    • utilize multimodal!!
  • blood transfusion during sx resection of colorectal cancers is associated with decrease in length of patient survivial
78
Q

What are some various procedures that can be performed for prostate ca?

A
  • Laparotomy- radical prostatectomy
    • lap or robotic
      • minimally invasive prostatectomy
  • cystoscopy-transurethral resection (TURP)
    • laser
  • Radiation therapy
    • external beam
    • implantation of radioactive seeds
79
Q

ANesthesia concerns for prostate ca surgery?

A
  • Surgery vs radiation rx
  • hormone therapy- for metaststic type
  • resistance to rx–> bone pain
  • chemotherapy- cyclophosphamide, 5FU, Cisplatin, doxorubicin- alone or in combo
  • High dose prednisone- subjective improvement
  • positioning: lateral, sometime steep t-berg
    • cognizant of pt eyes and vent changes
      • lots of blodo loss possible
  • when robot docked, pt needs to be completely paralyzed
80
Q

Anesthesia management for TURP?

A
  • General
  • Regional
    • epdiural
    • spinal
  • TURP- systemic absorption of irrigation fluid–> volume overload
    • not as big of concern now that we don’t use glycine
  • DIlutional hyponatremia a concern
  • regional anesthesia- allows assessment of neuro when hyponatremia is concern
  • Laser
    • general
    • eye prection, fire risk
    • regional
      • epidural
      • spinal
81
Q

Concerns for head/neck cancer sx?

A
  • Possibility of distorted airway anatomy
  • review imaging studies and develop plan
  • dysphagia–> increased risk for aspiration
  • ENT surgeon at bedside during induction
    • esp if airway concern
  • positioning- sometimes patients far away, need stellar IV
82
Q

Anesthesia management for diagnosit suspension laryngoscopy/scope

A
  • Fiberoptic rigid scope
    • general TIVA w ETT (large size)
    • jet ventilation
    • arms tucked
83
Q

Anesthesia management for neck dissection?

A
  • General
    • hold NDMR for nerve preservation
  • Radical neck disection
    • general with ETT (maybe awake, maybe trach at beginning)
    • Aline, 2 large bore IV, T&C, hold NDMR
  • General with ETT- oral vs nasal depends on sx exposure
    • impaired ROM and mouth opening- fiberoptic
      • dyspnea-upright positioning
      • tracheal compression concern- avoid NMV
    • Airway may be inaccessible during case
    • concern with ETT compression- use armored tube
    • trachea- tube connections/access to pull ETT and reconnect
84
Q

Postop consideraiton for head/neck surgery?

A
  • prevent PONV
    • must provide reassurance that measure will be taken to attempt to contorl PONV
  • Treatment PONV
    • anti emetics
    • anesthetic technique
    • adjuncts

Co-existing Test 1 (4 decks)

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