Cancer

Question 1

What are some special anesthetic considerations when caring for a patient with neck/throat cancers?

Answer 1

review imaging to decide if advanced airways are necessary
ask questions about dyphagia and dyspnea
prepare for non-patent airway if soft tissues collapse during resection
surgical blood loss may be significant so have 2 PIVs and t+s
may not have great access to airway during the case

Question 2

What factors are used to grade tumors?

Answer 2

size, lymph node involvement, metastases

Question 3

What are the associated hematologic effects in a cancer patient? How can you prepare?

Answer 3

anemia r/t bone marrow suppression with drug therapies
neutropenia and thrombocytopenia may also be evident!

*use aseptic technique, pre-op antibx, have type and cross and blood units available, oxygenate them well

Question 4

What are some neuromuscular effects associated with cancer patients? How can you prepare to handle them?

Answer 4

musculoskeletal weakness
neuropathies and pain
spinal cord compression

*position extremely carefully, carefully choose neuromuscular blockers, control pain

Question 5

What are the physiologic effects of cancer on the pulmonary system? How can you prepare?

Answer 5

pulm edema, CHF, pleural effusions, pneumonitis
different types of lung CA tumors will secrete hormones into the blood

*know background of the CA, get a CXR, how are the associated symptoms being treated?

Question 6

Small cell lung CA can cause…?

Answer 6

SIADH or Cushing’s syndrome

Eaton-Lambert syndrome (myasthenic like symptoms)

Question 7

large cell lung CA can cause….

Answer 7

gynecomastia

Question 8

adenocarcinomas in the lung can cause

Answer 8

osteoarthritis and hyper-coagulable states

Question 9

squamous cell lung CA can cause…?

Answer 9

hypercalcemia!

Question 10

What are the special considerations for a cancer patient who is receiving hyperalimentation?

Answer 10

do NOT turn it off for the OR because it can cause electrolyte imbalances and most importantly could cause hypoglycemia

Question 11

How is the GI physiology disrupted in a CA patient?

Answer 11

anorexia and weight loss may be present
electrolyte abnormalities and malabsoroption may exist, so get a EKG
*ex. hypercalcemia r/t bone mets OR Na/K changes with N/V/diarrhea

Question 12

How is the renal system affected in a cancer patient?

Answer 12

adrenal insufficiency may occur r/t immunosuppression with steroid treatments

Question 13

How is the CV system affected in a cancer patient?

Answer 13

when the heart is subjected to malignancies, you can have paroxysmal a-fib, flutter or pericardial tamponade (esp in lung CA)

drug induced cardiomyopathies can occur from chemo

SVC obstruction can occur when mets get to the mediastinum
*symptoms = venous engorgement above the waist, dyspnea, airway
obstruction

Question 14

How does your anesthetic management change if you suspect SVC obstruction in a cancer patient?

Answer 14

prepare for an awake fiberoptic intubation

Question 15

what are your concerns if the patient has taken doxorubicin or daunorubicin? How can you prepare?

Answer 15

cardiac toxicity and cardiomyopathies that could persist up to 3 years!!

avoid use of nitrous oxide to prevent further cardiac depression and use caution with other anesthetic gases because they have cardiac depressant effects as well

Question 16

What are your concerns if a cancer patient tells you they have taken methotrexate? How can you prepare?

Answer 16

immunosuppression (aseptic technique, pre-op anti-bx, etc.)
pulmonary edema
progressive pulmonary inflammation with effusions
dementia with prolonged use

*get a CXR, check gas exchange with SaO2, ETCO2, ABG, etc.

Question 17

What are your concerns if the patient has been taking bleomycin? How can you prepare?

Answer 17

dose related pulmonary toxicity that can cause fibrosis and hyperoxic pulm injury

*manage this by titrating O2 sat for >90% with FiO2

Avoid fluid overload that might thicken the alveolar gradient

Question 18

What are your concerns if the patient has been taking 5-flurouracil? How can you prepare?

Answer 18

immunosuppression, leukopenia and megaloblastic anemia

*have CBC drawn up, T&S, blood available, aseptic technique for infection risk, pre-op antibx

Question 19

What are your concerns if the patient has been taking Cisplatin?

Answer 19

• renal toxicity can occur and progress to ATN/ARF and hemodialysis
• neuropathies possible

*treat toxicity with fluids and osmotic diuretics

Question 20

What are your concerns for the patient who has been taking Cyclophosphamide? How can you prepare?

Answer 20

acute delirium!

*get baseline neuro status, careful with opioids and benzos

Question 21

What are your concerns if the patient has been taking Vincristine? How can you prepare?

Answer 21

peripheral and autonomic neuropathies can occur

*review VS, pain status, orthostatics?

Question 22

What are the concerns for a patient who has been taking Cytoxan?

Answer 22

acts as a plasma cholinesterase inhibitor and may prolong the action of succinylcholine

Question 23

What are some good therapies used to treat N/V in cancer patients?

Answer 23

metoclopramide/reglan
droperidol
zofran

Question 24

What are some of the adverse effects of radiation therapy?

Answer 24

fibrosis
limited ROM
diarrhea
cystitis
cardiomyopathy

Question 25

What are the special considerations when caring for a patient with lung CA?

Answer 25

pulmonary insufficiency may result after lung resection
potential for massive blood loss during resection
if smoking r/t CA, may have CAD as well