Anesthesia for extrathoracic surgery

Question 1

Pre-op assessment for extrathoracic surgery

Answer 1

patient’s premorbid status, including adverse effects from any neoadjuvant hormonal, chemo,or radiotherapy, should be considered

Question 2

chemotherapeutic agents(e.g. cyclophosphamide and doxorubicin) used in breast cancer can result in

Answer 2

Cardiac toxicity, including cardiomyopathy and prolongation of the QT interval. These events can occur at any stage after treatment, even years after the initial chemotherapy regimen.

The patient should be assessed for symptoms of cardiac dysfunction before surgery, and investigations, such as ECG or echocardiography, may be required.

Question 3

Hematopoietic adverse effects of neoadjuvant therapy, such as myelosuppression manifest as

Answer 3

Perioperative anemia, the increased bleeding risk from thrombocytopenia, and neutropenia predisposing to sepsis.

Identification and management of issues should occur before surgery

Question 4

TRUE OR FALSE Hormonal agents (e.g. tamoxifen or aromatase inhibitors) used in neoadjuvant treatment may be continued in the perioperative period

Answer 4

True

Question 5

TRUE OR FALSE Monoclonal antibody, trastuzumab (Herceptin), for human epidermal growth factor receptor 2-positive tumors. They are cardiotoxic and may increase the risk of perioperative venous thromboembolism(VTE).

Answer 5

True

Question 6

Intraoperative Management for extrathoracic surgery

Answer 6

Induction of anesthesia should proceed by using standard monitors.

Options include using IV or inhalation methods and maintained using TIVA or a combination of inhalation and IV agents.

Question 7

It is important to insert the IV in the __________arm to the surgery, particularly where axillary clearance is planned to avoid _______________and optimize surgical access to the breast axilla.

Answer 7

It is important to insert the IV in the contralateral arm to the surgery, particularly where axillary clearance is planned to avoid upper limb lymphoedema and optimize surgical access to the breast and axilla.

Question 8

Intraoperative monitoring for extrathoracic procedures

Answer 8

Hemodynamic monitoring includes invasive arterial pressure monitoring, depending on theprocedure and the patient’s co-morbidities.

It is particularly important to consider if the patient has cardiac complications from neoadjuvant therapy.

For those having procedures >30 min, temperature monitoring should be used and normothermia maintained. This is achieved most efficiently using a convective forced-air warmer, warmed fluids, and increasing the ambient temperature.

Question 9

Shorter procedures may suit the use of ___________________ for airway management.

Longer procedures, particularly where positioning other than supine is considered (e.g., for flap reconstruction), would be more suitable for airway management using _______________

Answer 9

Shorter procedures may suit the use of supraglottic airway devices for airway management.

Longer procedures, particularly where positioning other than supine is considered (e.g., for flap reconstruction), would be more suitable for airway management using tracheal intubation.

Question 10

For those having flap surgery, particularly free flaps, attention should particularly be paid to the avoidance of _______________, _________________, and ______________to aid in perfusion of the flap during surgery.

Adequate ventilation of the lungs with a normal ______ and ___________ will improve perfusion

It is imperative to avoid the excessive administration of IV fluids to reduce the incidence of postoperative _______________

Answer 10

For those having flap surgery, particularly free flaps, attention should be paid to avoiding hypothermia, hypovolemia, and vasoconstriction to aid in the perfusion of the flap during surgery.

Adequate ventilation of the lungs with normal PCO2 and PO2 will improve perfusion.

it is imperative to avoid the excessive administration of IV fluids to reduce the incidence of postoperative tissue edema.