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
