Cancer Flashcards
What are the Preoperative Assessent Components for a patient with cancer?
- Dx- Proposed Procedure
- Medical/ Surgical History
- Current Medications
- Allergies
- Physical Exam- Heart/Lungs/Vital Signs/ Airway
- Laboratory Testing/Diagnostic Testing-ECG, CXR, PFTs
- ASA Class Assignment
- NPO status
- Formulate Plan and Discuss
- Informed Consent
- Document
What are some cancer preop questions for the Hematologic?
- Do you have a history of anemia?
- Are you prone to infections?
- Do you easily bruise or bleed or have a history of blood clots?
What are some cancer preop questions for the Neuromuscular System?
- Do you have pain? Where?
- Do you have numbness? Tingling in extremities?
- Anorexia/Weight loss? Hyperalimentation?
- Nausea/ vomiting? Diarrhea?
- Are you on corticosteroids?
What are some cancer- Preop questions regarding the pulmonary system?
- Do you have frequent lung infections or pleural effusions?
- If the patient has specifically:
- Adenocarcinoma (30-50%)à history of blood closts? Osteoarthritis?
- Large cell –gynecomastia?
- Small cell -muscle weakness?
- Pain in hands, fingers, knees, ankles?
What are some cancer preop questions regarding the cardiac system?
- Do you have a cardiomyopathy?
- Do you experience arrhythmias?
- Can you lie supine or are you symptomatic when supine?
What are some cancer preop questions regarding the renal system?
- Any decrease in your kidney function?
- Experienced any ureteral obstruction?
- Is your skin itchy?
What are some cancer preop questions regarding the hepatic system?
- Any decrease in your liver function?
- Do you bruise or bleed easily?
What are some other cancer preop questions?
- Fever and cachexia?
- Neurologic abnormalities? Confusion? Agitation?
- Headache, nausea, ataxia, lethargy, seizures?
- Dermatologic abnormalities?
Preop Considerations for lung cancer surgery?
- Associated coronary artery disease
- Pulmonary insufficiency after lung tissue resection
- Potential for massive blood loss during surgical resection
- Special equipment needed
Labs:
- Preoperative PFTs, DLCO, VO2 max, CXR, ABGs, O2sat
- ? Cardiac stress testing
- HCT/Hbg, T&C
Preop considerations for Breast Cancer surgery?
- Poor IV access
- At risk for lymphedema- avoid Ivs and BP cuff on surgical arm
- Check type of chemotherapy for complications
Preop Considerations for Colon/GI cancer surgery?
- May be aspiration risk- give preop aspiration risk prophylaxis (no Reglan)
- May be dehydrated from colon prep and/or obstruction- preop IV fluid
- May need T & S or T & C
Preop considerations for prostate cancer surgery?
- Robotic surgeries
- Special positioning (steep Trendelenburg)
- Frequently on high dose prednisone- need replacement steroids
Preop considerations for Head and Neck Cancer?
Special anesthetic considerations:
- Review imaging studies to determine if alternate airway management plan should be used
- Question the patient regarding dysphagia and difficulty breathing (signs of airway obstruction)
- Surgical blood loss can be significant: T&C, CBC
- Lack of accessibility to airway during case: special equipment
- Hypercalcemia related to METS: check calcium level
- Alcohol-induced liver disease: check LFTs
- Chronic smoking hx- PFTs, pulm toitlet, inhalers
- May need nutritional therapy preop
- Plan for difficult a/w
- May need invasive monitoring- esp A-line
What are some adverse Effects of CA treatments?
- Bone marrow suppression
- Cardiovascular toxicity
- Pulmonary toxicity
- Central and peripheral nervous system damage
- Renal toxicity
- Hepatic toxicity
- GI/Endocrine changes
- Other: mucositis, ototoxicity, renal insufficiency
What are some labs and test you would want for a cancer patient?
- Hematocrit-Anemia
- Platelet Count-Thrombocytopenia
- WBC count-Neutropenia
- Liver function
- PT/ PTT/ INR (coag studies)
- BNP
- CXR - tracheal deviation or compression, masses, aortic aneurysm, fractures (ribs, clavicle, vertebrae), cardiomegaly, pulmonary edema, pneumonia, atelectasis, chronic disease
- 12-lead ECG - Abnormalities that will alter anesthetic plan include: Afib, Aflutter, Heart Blocks, ST-T segment changes indicating ischemia, infarct or recent PE, PV & PACs, LVH, RVH, WPW, prolonged QTI or shortened PRI, peaked T waves
- Renal function-BUN/Creatinine clearance
- Electrolytes
- Ca++hypercalcemia due to bone mets and osteolytic activity.
- K+, Na++, Ca++, Mg
- Blood glucose
- ABGs
- ECHO
- PFTs
