Mod11: Radiation Therapy - Cardiac Catheterization - AICD implantation Flashcards
Anesthesia for Radiology & Radiation Therapy
When does anesthesia usually gets envolved in Radiation Therapy?
When Radiation Therapy is performed in children
Anesthesia for Radiology & Radiation Therapy
What is Radiation Therapy?
External beam radiation
Used in the Treatment of malignancies
Anesthesia for Radiation Therapy
Over what period of time does Radiation Therapy treament takes places?
Series of treatments over several weeks
First Tx last about 2 hrs
Subsequent Tx last about 30 min per Tx
Anesthesia for Radiation Therapy
Why must all personel leave the room during Tx?
V_ery high dose_ radiations are emitted
Pt cannot be directly observed during Tx
Must have all your monitors properly placed for remote viewing
In case of emergency, procede as with MRI
Stop radiation
Anesthesia for Radiation Therapy
Why are patients receiving External beam radiation at risk for sepsis, thrombocytopenia, anemia?
Chemo!!!
Many received cytotoxic and
immunosuppressant chemotherapy
before radition therapy
This is more relevant when providing surgical anesthesia care because of its effect in terms of infection and bleeding time
Anesthesia for Radiation Therapy
What will you have to do if they move during therapy?
You will have to reorganize everything
Anesthesia for Radiation Therapy
Why should you focus on keeping the pt comfortable for short periods at the time?
Radition Therapy has Rapid onset
w/ Brief duration of action &
Rapid recovery
Anesthesia for Radiation Therapy
True or False: radiation therapy is painful to administer
False
Radiation therapy is Not painful to administer
It is stimulating and they must remain immobile
Keeping them immobile is your priotity
Anesthesia for Radiation Therapy
What’s the concern with airway maintenance during radiation therapy?
Variety of different body positions makes airway maintenance difficult
Anesthesia for Radiation Therapy
What are choices of Anesthetic Techniques with radition therapy?
General anesthesia
Deep sedation*
Goal is to prevent pt movement
Anesthesia for Radiation Therapy
Intraoperative radiation to tumor masses is radiation therapy provided after surgical exposure in the OR. These masses could be of which types?
Pancreatic, colon, rectal, ovarian, cervical, breast
Anesthesia for Radiation Therapy
Which type of anesthesia is used for intraoperative radiation?
Usually requires General anesthetic
Regional may be feasible for cervical/rectal
Anesthesia for Radiation Therapy
Pts requiring intraoperative radiation may require transport back and forth from OR to radiation suite, what must be present to ensure pt’s safety throughout?
Portable monitors
Methods of O2 delivery
Agents to maintain general anesthesia/sedation
Anesthesia for Radiation Therapy - Intraoperative radiation
Pt’s requiring intraoperative radiation typically suffer from advanced cancer. What associated metabolic derrangements should you plan for?
Malnutrition
Electrolyte imbalances
Dehydration
Coagulopathies
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
Which type of anesthesia do minimal diagnostic & Therapeutic Cardiac Catheterization procedures require?
Light sedation only
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
Which more complex procedures requiring more invasive monitoring and general anesthesia are performed in Cardiac Catheterization?
Pediatric patients with CHD
(Less than 6 mo, requiring ETT, often pre major OHS)
Removal AICDs
Endovascular stenting of thoracic/abdominal aortic aneurysms
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
What’s the main purpose of Electrophysiologic Procedures?
Ablation of abnormal conduction pathways for treatment of dysrhythmias caused by aberrant conduction pathways
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
Why do Electrophysiologic Procedures require sedation or general anesthesia (esp. children)?
Because they are Lengthy & painful!!!
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
Why are Electrophysiologic Procedures lengthy?
Takes time to located the focus needing ablation
Pt’s response to ablation unknown
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
Why are Electrophysiologic Procedures painful?
They are changing the rate and rhythm of the heart, while
Burning and freezing inside the chest itself
This why they require Deep sedation or GA
(esp. younger children)
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
How is General anesthesia provided during Cardiac Catheterization?
Combination of volatiles and propofol
Not shown to interfere with cardiac conduction during these procedures
Could also use “Room Air General” + Propofol + Remi
(Oxygen via face mask)
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
What should you consider when deciding between a TIVA vs. volatile anesthetics in children?
GA is associated with high incidence of N/V children
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
Which types of drugs should never be given in the EP lab?
Any drug that could change the Heart rhythm
No Lidocaine => will stabilize the heart => will prevent localization of dysrhythmias
No versed => versed will knock out dysrhythmias => EP wants to localize where they originate so they can be treated
No volatile agents alone => May give volatile agents mixed with propofol => volatile agents alone will knock out dysrhythmias
No Phenylephrine => will cause bardycardia
No Ephedrine => will cause tachycardia
Give Vasopressin for pressure support
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
Why should Lidocaine Not be given in the EP lab?
It will stabilize the heart
This will prevent localization of dysrhythmias
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
Why should Versed Not be given in the EP lab?
Versed will knock out dysrhythmias
EP wants to localize where they originate so they can be treated
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
Why should volatile agentsNot be given alone in the EP lab?
Volatile agents alone will knock out dysrhythmias
May give volatile agents mixed with propofol
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
Why should Phenylephrine Not be given in the EP lab?
It will cause bardycardia
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
Why should Ephedrine Not be given in the EP lab?
It will cause tachycardia
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
What is the appropriate pressor to use in the EP lab?
Vasopressin
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
Why should you administer smaller doses of anesthetic agents in the EP lab and give it time to work?
Most patients have low EF, and
Longer circulatory time
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
True or False: Pts who cannot lay flat or those undergoing RHC often require ETT
True
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
Why are AICDs implated?
To reduced mortality in patients with
Ventricular Tachyarrhythmias and LVD due to MI
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
In which clinical area are AICDs typically implated?
In the EP lab rather than operating room
(Not unusual to see them implanted in the OR)
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
AICD implantation is not a painful procedure but which part of the procedure is distressing
Induction of VF to test device
Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization
Which anesthetic technique is appropriate for AICD implantation?
Deep sedation usually
(Versed/Fentanyl; Propofol/Remi; Propofol/Fentanyl boluses)
Airway instrumentation is rare
General anesthesia possible
