Cancer Flashcards
What are some cosiderations for GA in patients with cancer?
- May need to correct nutrient deficiencies, electrolyte abnormalities, anemia, and coagulopathies before surgery
- Labs: CBC, coags, LFT, electrolytes, and transaminase levels
- Tests: CXR, ECHO, PFT
- Various things related to medications (separate card)
What should you consider in a patient who has been receiving Bevacizumab
- Ideally surgery would wait until 4-8 weeks after treatment because of increased risk of bleeding and poor wound healing
What should you consider in patients who have been receiving Doxorubicin
- Can be cardiac toxic; causing cardiomyopathies and arrhythmias
- The myocardial depressant nature of anesthesia can unmask cardiac dysfunction
- monitor EKG for arrhythmias
What should you consider in patients who have been treated with Bleomycin
- they may have pulmonary fibrosis
- These patients are at high risk of developing pulmonary edema
- You should get ABGs as well as monitor SpO2
- carefully titrate IV fluid replacement
- Keep O2 as low as necessary, it may exacerbate problems in these patients
What should you consider in patients who have been treated with Methotrexate?
- Avoid N2O, which can augment toxicities caused by methotrexate
What should you consider if you want to administer Succinylcholine to your patient with cancer?
- They may have prolonged effect
- Cyclophosphamide- inhibits pseudocholinesterase
What are paraneoplastic syndromes?
- Symptoms caused by the immune response to a tumor
- Fever
- cachexia
- neurologic abnormalities
- endocrine abnormalities
- renal abnormalities
- dermatologic and rheumatologic abnormalities
- hematologic abnormalities
What aspects of cancer may directly affect airway management?
- oral mucusitis- cause bleeding during laryngoscopy
- radiation fibrosis
- tumor distorion of airway
Why is regional anesthesia sometimes preffered over GA in cancer patients?
What should you consider if you decide to use regional?
- because some inhaled agents and opioids can cause immuno suppression that allows the tumor to proliferate
- check coagulopathies
What are the anesthesia needs for a diagnostic-flexible fiberoptic bronchoscopy?
What is this procedure done for?
- Need GA
- need 7.5 or bigger ETT
- Can lose volumes and IA during scope
- consider TIVA
- Done for biopsies, brushings, and washings
What are some general concerns regarding lung cancer?
- involvement of lung impacts ventilation
- pts tend to also have CAD (often they are smokers)
- Pain
- upregulated opioid receptors–may need more opioids
- Ectopic endocrine effects
- 3% of pts are cushingoid
- 60% with lung cancer have inappropriate ADH (SIADH)
What is a VATS procedure done for?
What are the anesthesia needs?
- Video assisted thoroscopy surgery
- biopsy wedge resection, lobectomy, lymphectomy
- General Anesthesia
- A-line, fluid restriction, lateral position
- One lung ventilation
- double lumen ETT
- one lung ventilation, peep on “up” lung
- CPAP on “down” lung
- Frequent ABGs, 100% FiO2
- Plan for pulmonary insufficiency and chest tube post op
- Potential for massive blood loss
- T&C, 2 large bore IVs, check H&H intraop, blood warmer
- Thoracic epidural for post of pain management- place prior to induction
- Lateral position can cause V/Q mismatch and nerve injuries
- monitor UOP
What is a mediastinoscopy done for?
What is the anesthesia management?
- Done for lymph node biopsies
- GA
- ETT with controlled ventilation, concerned for pneumothorax
- Depending on tumor location, it may compress the trachea after NMB, may need awake fiberoptic intubation
- Scope can put pressure on R subclavian
- If pulse ox and A-line are on the R side, it may cause loss of pulse and false cardiac arrest
- Probably want to put A-line on left and pulse ox on R because if you lose perfusion, you know that they also arent getting blood into their internal carotid
- May also see bradycardia if they strech the vagus
What is a thoracotomy done for?
What is the anesthesia management?
- complex pneumonectomy
- General Anesthesia
- A-line, fluid restriction, lateral position
- One lung ventilation
- double lumen ETT
- one lung ventilation, peep on “up” lung
- CPAP on “down” lung
- Frequent ABGs, 100% FiO2
- Plan for pulmonary insufficiency and chest tube post op
- Potential for massive blood loss
- T&C, 2 large bore IVs, check H&H intraop, blood warmer
- Thoracic epidural for post of pain management- place prior to induction
- Lateral position can cause V/Q mismatch and nerve injuries
- monitor UOP
Explain how a double lumen ETT works
What are the breast cancer surgeries?
What kind of anesthesia would you want for each?
- Biopsy
- local with sedation or GA after radiology with needle placement
- Lumpectomy with radiation therapy- GA
- simple mastectomy- GA
- modified radical mastectomy- GA
- radical mastectomy- removal of involved breast, axillary contents and underlying chest wall musculature; node dissection- GA, ETT
What are some general concerns regarding breast cancer surgery?
- Avoid IV or BP on operative side
- Tamoxifen- increased risk of thromboembolic events and can cause body temp disturbances
- Isosulfan blue dye for lymph node mapping is associated with anaphylaxis in 1%
- transiently affects oximetry
What are some general concerns for colon/GI cancer surgery?
- Radiation- diarrhyea, cystitis (UTI)
- Bowel prep–>hypovolemic–>tachycardic, hypotension
- Ascites from low albumin levels
- anemia
What is the anesthesia management of Colong/GI surgery?
- Diagnostic endoscopy
- Sedation
- GA-TIVA, natural airway
- Laparoscopic
- GA- ETT, ?RSI
- Regional- Epidural
- Hypovolemia- avoid drugs which cause hypotension or decrease dose
- NO N2O!
- Decrease doses of highly PB drugs if pt has low albumin
- Decrease MAC if pt is anemic
- Avoid metoclopramide with obstruction
What are some general considerations for Prostate cancer surgery?
- Pt will probably have had radiation
- May be receiving hormone therapy if cancer is metastatic
- may have bone pain from metastasies
- May be positioned laterally (nerve risk) or steep trendellenberg (increase head/airway edema, ICP, etc)
What is the anesthesia management of prostate cancer surgery?
(4 different surgeries)
- Open laparotomy- lots of pain
- GA or Regional
- Laparoscopy or robotic
- GA w/ETT
- steep trendellenberg
- TURP
- GA or Regional
- may have systemic absorption of irrigation fluid causing volume overload and dilutional hyponatremia
- Laser
- GA or Regional
- eye protection of patient and provider
- fire risk
What are some general concerns with head and neck cancer surgeries?
- possibility of distorted airway anatomy
- review imaging before and develop a plan
- dysphagia- increased risk of aspiraton
- ENT surgeon at bedside during induction
What is the anesthetic management for diagnostic suspension laryngoscopy?
(for head and neck cancer)
- Fiberoptic/rigid scope
- GA TIVA w/ small sized ETT and jet ventilation
- arms tucked
What is the anesthetic management for Radical neck dissection?
- GA w/ ETT (maybe awake, or maybe tacheostomy at beginning)
- Oral vs nasal ETT depends on surgical plan
- pt may have impaired ROM and mouth opening (intubate with fiberoptic)
- Airway may be inaccessible during the case- tubing extensions
- Use armored tube to prevent ETT compression
- No NDMR- for nerve preservation
- A-line, 2 large-bore IVs, T&C
