Cancer - Co-Existing

Question 1

Anesthetic Technique: Lung Cancer: Mediastinoscopy

1. Airway?
2. Breathing/concerns?
3. Circulation? Scope concerns? Causes of Bradycardia?

Answer 1

1. ETT
2. controlled vent/pneumothorax
3. pressure on the R subclavian = loss of pulse (need Aline on L side) — stretching of vagus/trachea causes bradycardia

Question 2

Anesthetic Technique: Lung Cancer: Open Lung Biopsy

1. Anesthesia Technique?
2. Airway?
3. Breathing/Tumor location?

Answer 2

1. General
2. ETT
3. Compression - awake fiberoptic (for ETT)

Question 3

Anesthetic Technique: Lung Cancer: Thoracotomy

1. Anesthetic Technique?
2. Airway?
3. Breathing/One lung ventilation?
   * potential for massive blood loss with resection

Answer 3

1. General
2. Double lumen ETT
3. Up lung = CPAP, down lung = PEEP, 100 FiO2 ( ABGs)

Question 4

Anesthetic Technique: Lung Cancer: Drugs!

1. Preop pain meds- AVOID?
2. Bronchodilator: meds?
3. Drugs to avoid?
4. Post op pain management?

Answer 4

1. resp depression
2. IAs
3. N2O and Histamine releasing meds
4. Thoracic epidural - placed prior to induction

Question 5

Anesthetic Technique: Lung Cancer: Fluids

1. Hemorrhage: ???
2. Infusion: temp?
   * monitor UOP

Answer 5

1. T and C, 2 large IVs, check intraop H/H

2. decreased temp - fluid warmer

Question 6

Anesthetic Technique: Breast Cancer: Biopsy

1. Technique?
   
   • general: after radiology with needle placement
2. Airway?
   * Breathing- ambu/suction/all airway equip

Answer 6

1. Local with sedation

2. NC O2/chin lift

Question 7

Anesthetic Technique: Breast Cancer: Lumpectomy

1. Technique?
2. Airway/Breathing?

Answer 7

1. GA

2. LMA (spontaneous vent + assist)

Question 8

Anesthetic Technique: Breast Cancer: Mastectomy

1. Technique?
2. Airway/Breathing?

*Radical mastectomy/node dissection = GA

Answer 8

1. GA

2. ETT/controlled vent

Question 9

Anesthetic Technique: Breast Cancer: Fluids/Circulation/Drugs

1. Fluids: IV and BP cuff?
   * Preop opioids for pain relief
   
   • chemo influences med admin

Answer 9

1. place on non-operative side

Question 10

Anesthetic Technique: Colon Cancer/GI: Endoscopy (Diagnostic)

1. Technique?
2. Airway?
3. Breathing?

Answer 10

1. GA- TIVA + Sedation
2. NC O2/chin lift
3. A/w equip, ambu, suction

Question 11

Anesthetic Technique: Colon Cancer/GI: Laparotomy w/ Radical Surgical Resection

1. Technique?
2. Airway?
3. Breathing?

Answer 11

1. General, Regional (epidural)
2. ETT (+ RSI?)
3. controlled vent (NMB) or awake intubation (RSI)

Question 12

Anesthetic Technique: Colon Cancer/GI: Laparoscopic/Laparotomy

1. Technique?
2. Airway??
3. Breathing (RA concerns?)

Answer 12

1. General or RA
2. GA = ETT (RSI), RA = NC O2
3. Increase O2

Question 13

Anesthetic Technique: Colon Cancer/GI: Circulation/Fluids

1. Bowel Prep: concerns??? Fluids:
2. Ascites: concern? 3. preop hypovolemia = ?
   4. CVP to monitor?
   - 3rd space loss, T/C, UOP

Answer 13

1. hypovolemia, tachycardia, hypotension
2. low albumin levels
3. preop hydration
4. fluid shifts

Question 14

Anesthetic Technique: Colon Cancer/GI: Drugs

1. Hypovolemia: Avoid? 5. Aspiration med: Avoid?
2. Avoid (gas)? 6. Laparotomy: Need?
3. High PB drugs?
4. Anemia concerns?

Answer 14

1. cause hypotension (decrease doses)
2. N2O
3. lower doses if albumin low
4. decrease MAC
5. metoclopramide
6. muscle relaxation for retractors

Question 15

Anesthetic Technique: Prostate Cancer: Open/Laser/Scope (TURP)

1. Technique Options?
2. Airway: GA/RA?
3. Breathing?

Answer 15

1. GA or RA (epidural/spinal)
2. GA (LMA or ETT), RA (natural a/w, NC O2)
3. LMA - spon vent + assist, ETT - controlled vent, NC - O2, ambu, equip

Question 16

Anesthetic Technique: Colon Cancer/GI: TURP

1. Circulation:
   
   • Irrigation fluid concerns?
2. Fluids: concern w/ low Na?
3. Check intraop?
4. RA - allows assessment of neuro fxn during concern of?

Answer 16

1. systemic absorption = volume overload and dilutional hyponatremia
2. admin NS (0.9%)
3. Na levels
4. hyponatremia

Question 17

Anesthetic Technique: Head and Neck Cancer: Diagnostic Procedures

1. Fiberoptic Rigid Scope: Technique?
2. Mediastinoscopy: Technique?
3. Airway? Tube?
4. Breathing? Meds/Consideration/Concerns?

Answer 17

1. GA
2. GA
3. ETT (oral vs. nasal), armored tube
4. Jet ventilation (via bronchscope), NMB, Passive Exhalation, Barotrauma

Question 18

Anesthetic Technique: Head and Neck Cancer: Biopsy

1. Technique?
2. Airway?
3. Breathing/Check with surgeon regarding?

Answer 18

1. Local with Sedation or GA
2. Local - natural a/w, spont respirations
3. controlled vent/ NMB

Question 19

Anesthetic Technique: Head and Neck Cancer: Dissection

1. Technique?
2. Airway? Preserve? Avoid?
3. Breathing?

Answer 19

1. GA
2. ETT (armored), preserve nerve fxn, No NMB
3. Controlled ventilation

Question 20

Anesthetic Technique: Head and Neck Cancer: Circulation/Fluid/Drugs

• Circulation *Fluids *Drugs
  1. Carotid compression? 3. Access/Position? 4. nerve fxn assess?
  2. Laceration? * blood avail/UOP
• +/- Aline

Answer 20

1. Bradycardia
2. Hemorrhage
3. 2 large IVs/arms tucked
4. No NMB

Question 21

Anesthetic Technique: Lung Cancer: Bronchoscopy (Diagnostic)

1. Anesthetic Technique?
2. Airway?
3. Breathing?

Answer 21

1. General-TIVA + sedation
2. NC O2/chin lift/ side port O2
3. increase liter flow O2