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Flashcards in Cancer Deck (25)
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1

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

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

2

What factors are used to grade tumors?

size, lymph node involvement, metastases

3

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

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

4

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

musculoskeletal weakness
neuropathies and pain
spinal cord compression

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

5

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

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?

6

Small cell lung CA can cause...?

SIADH or Cushing's syndrome

Eaton-Lambert syndrome (myasthenic like symptoms)

7

large cell lung CA can cause....

gynecomastia

8

adenocarcinomas in the lung can cause

osteoarthritis and hyper-coagulable states

9

squamous cell lung CA can cause...?

hypercalcemia!

10

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

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

11

How is the GI physiology disrupted in a CA patient?

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

12

How is the renal system affected in a cancer patient?

adrenal insufficiency may occur r/t immunosuppression with steroid treatments

13

How is the CV system affected in a cancer patient?

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

14

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

prepare for an awake fiberoptic intubation

15

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

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

16

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

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.

17

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

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

18

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

immunosuppression, leukopenia and megaloblastic anemia

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

19

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

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

*treat toxicity with fluids and osmotic diuretics

20

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

acute delirium!

*get baseline neuro status, careful with opioids and benzos

21

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

peripheral and autonomic neuropathies can occur

*review VS, pain status, orthostatics?

22

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

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

23

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

metoclopramide/reglan
droperidol
zofran

24

What are some of the adverse effects of radiation therapy?

fibrosis
limited ROM
diarrhea
cystitis
cardiomyopathy

25

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

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