Perioperative Care of the Cancer Patient

Cover
IFC
Perioperative Care of the Cancer Patient
Copyright
Dedication
Contributors
Preface
Contents
Section 1: Basic Principles (Epidemiology;
Cancer Biology; Overview of Cancer
Therapies)
1 - Cancer Epidemiology, Prevention, and Survivorship
Introduction
Cancer Epidemiology
Cancer Burden in the World
Cancer Prevention and Early Detection
Lifestyle Prevention
Screening/Early Detection
Chemoprevention
Cancer Survivorship
References
2 - Global Cancer Surgery—The Lancet Commission
Introduction
The Global Surgical and Anesthesia Crisis
Emergence of Global Surgery
Perioperative Management
Cancer Anesthesia and Surgery
Surgical Access
Safe Anesthesia
Pain Management
Palliative Pain Management
Future Advances for the Surgical and Anesthesia Management of Cancer Patients in Low-Income Countries
Recommendations
Conclusions
References
3 - Cancer Biology and Implications for the Perioperative Period
Introduction
Development of a Tumor
Nature of a Tumor
Proliferative Signaling and Cell-Cycle Deregulation
Evading Cell Death
The Tumor Microenvironment
Tumor Immune Landscape
Angiogenesis
Reprogramming Cellular Energy Metabolism
Invasion and Metastasis
Epithelial-Mesenchymal Transition
Circulating Tumor Cells
Colonization
Metastatic Outgrowth
Approaching Cancer Biology in Perioperative Medicine
References
4 - Traditional Cancer Therapies and Perioperative Implications
Introduction
Cardiovascular
Pulmonary
Renal
Nervous System
Gastrointestinal
Hematologic
Endocrine
Premature Aging
Conclusion
References
5 - Newer Cancer Therapies and Perioperative Implications
Introduction
Surgical Considerations
Chemotherapy and Targeted Therapy
Newer Systemic Treatments: Immunotherapy
Radiation Therapy and Newer Techniques
Intraoperative Radiation Therapy
Brachytherapy
Radionuclide Therapy
Newer Radiation Techniques
Reducing Toxicity
Proton Beam Therapy
Stereotactic Body Radiotherapy
Adaptive Radiation Therapy
Conclusion
References
6 - Cancer and Heart Disease
Introduction
Quantification of Systolic Function in Cardio-oncology
Diastolic Function and Detection of Cardiotoxicity
Cardiac Mechanics in Cardio-oncology
Cardiac Dysfunction and the Heart Failure Spectrum
Considerations in Radiation-Induced Heart Disease
Cardiac Tumors
Tumor Types, Physiology, and Treatment Considerations
Cardiac Tumor Therapies
Acute Coronary Syndromes
Clinical Presentation and Diagnosis
Treatment
Acute Pericarditis
Treatment
Pericardial Effusion and Cardiac Tamponade
Treatment
Conclusion
References
7 - Personalized Cancer Care
Introduction
Multidisciplinary Care
The Multidisciplinary Team
Imaging
Computed Tomography
Positron Emission Tomography
Molecular Aspects and Personalized Therapy
Treatment Modalities
Surgery
Radiotherapy
Chemotherapy
Monoclonal Antibodies
Immunotherapy
Conclusion
References
Section 2: Inflammatory-Immune
Responses, Perioperative Period, and
Cancer Outcomes
8 - Anemia, Thrombosis, Transfusion Therapy, and Cancer Outcomes
Introduction
Anemia
Burden of Anemia and Iron Deficiency in Cancer Patients
Pathophysiology of Anemia in Cancer
Influence of Anemia and Iron Deficiency on Outcome in Cancer Patients
Diagnosing Iron Deficiency in the Preoperative Cancer Patient
Management of Iron Deficiency and Anemia in the Perioperative Period
Transfusion- and Cancer-Related Outcomes
Clinical Evidence
Transfusion-Related Immunomodulation and Cancer Outcomes
Age of Stored Blood and Cancer Recurrence
Impact of Blood Transfusions on Outcomes of Patients With Cancers
Thrombosis
Hemostatic Dysfunction and Cancer
Importance of Prevention of Thromboembolism in Patients Undergoing Cancer Surgery
Risk-Directed Approach to Prevention Thromboembolism Associated With Cancer Surgery
Application of Prophylaxis in Cancer Surgery
Conclusion
References
9 - Improving Cancer Survival Through Perioperative Attenuation of Adrenergic-Inflammatory Signaling
The Perioperative Period—An Underutilized “Window-of-Opportunity” to Prevent Metastatic Disease
Perioperative Stress-Inflammatory Responses: the Prometastatic Edge of the Sword
ISRs Are Initiated Before Surgery
Inflammatory and Stress Responses Mutually Potentiate Each Other
Converging Intracellular Molecular Pathways of PGs and CAs
Direct Effects of PGs and CAs on Cancer Cells
ISRs and Immunity
ISRs and the Cancer Microenvironment
Addressing Perioperative Inflammation and Adrenergic Stress Responses
Perioperative Beta-adrenergic Blockade in RCTs
Perioperative RCTs of NSAIDs During Cancer Surgery
Perioperative Combined Blockade of Inflammatory Stress Responses
Safety Concerns
Conclusion
References
10 - Local Anesthetics and Cancer
The Perioperative Period Is Critical for Postsurgical Cancer Outcomes
Potential Detrimental Effects of Anesthetics and Opioid Analgesics
Indirect Benefits of Perioperative Local Anesthetics
Direct Effects of Local Anesthetics on Cancer Cells
Voltage-Activated Sodium Channel Oncochannelopathy
NaV1.5 Structure and Function
Muscarinic Acetylcholine Receptors
Conclusion
References
11 - Volatile and Intravenous Anesthetics and Cancer
General Introduction: Anesthesia and Cancer Progression
Mechanisms of Cancer Development and Progression
Molecular Actions of Anesthetics and Cancers
Preclinical In Vitro and In Vivo Studies of Cancer and Anesthetics
Inhalational Anesthetics
Sevoflurane
Isoflurane
Desflurane
Intravenous Anesthetics
Dexmedetomidine
Midazolam
Ketamine
Clinical Studies
Volatile and Total Intravenous Anesthesia Anesthetics
Dexmedetomidine, Ketamine, and Midazolam
Ongoing Clinical Trials
Implication and Conclusions
References
12 - Opioids and Cancer
Introduction
Mechanisms
Tumor Proliferation and Apoptosis
Tumor Cell Invasion, Migration, and Metastasis
Immunosuppression
Inflammation
Angiogenesis
Opioids Versus Opioid-Sparing Analgesia/Anesthesia for Cancer Surgery
Regional Anesthesia and Analgesia
NSAIDs
Local Anesthetics
Propofol
Clinical Trials Involving Opioids Versus Alternative Technique
Effect of Opioids in Clinically Diverse Patient Groups
Opioid Use in Noncancer Patients
Opioid Use During Cancer Surgery
Opioid Use Following Cancer Surgery
Opioid Use in the Palliative Care Setting
Complexities of Linking Opioid Use and Cancer Risk
Cellular Level (In Vitro)
Animal Level (In Vivo)
Human Level
Future Outlook and Conclusion
References
13 - Can Regional Anesthesia and Analgesia Influence the Risk of Cancer Recurrence?
What Is Regional Anesthesia?
General Benefits of Regional Anesthesia
How Regional Anesthesia Might Influence Cancer
Evidence for a Benefit of Regional Anesthesia in Cancer Surgery
In Vivo Data
Translational Studies
Retrospective Analysis
Prospective Evidence
Peripheral Nerve Blocks and Cancer Recurrence
Systematic Reviews and Meta-analysis
Conclusion
References
Section 3: Perioperative/Periprocedural
Care in the Cancer Patient
14 - Preoperative Evaluation and Medical Optimization of the Cancer Patient
Introduction
History and Physical Examination
Preoperative Testing
Cardiovascular Risk Assessment
Pulmonary Risk Assessment
The Older Patient
Cancer-Specific Concerns
Conclusion
References
15 - Functional Assessment and Prehabilitation
The Physiologic Impact of Cancer and Surgery on Patient Function
The Surgical Insult and the Importance of Preparing Patients for Stress
Functional Assessment and Risk Stratification
Prehabilitation
Exercise and Physical Activity for the Surgical Cancer Patient
Nutrition and the Importance of Protein for the Colorectal Cancer Patient
Psychologic Support
Medical Optimization: Glycemic Control, Anemia
Literature on Prehabilitation and Impact on Outcome
Prehabilitation as a Compelling Strategy: Successes and Challenges Ahead
References
16 - Redesign of Perioperative Care Pathways
Introduction
Drivers for Pathway-Based Care
Patient Versus Provider Perspectives
Health Policy Developments
Health Economics
Pathway Reengineering
Implications of Pathway-Focused Care
Before Surgery
Shared Decision-Making
Prehabilitation
Comorbidity Management
During Surgery
Minimizing Physiologic Harm
Standardizing Individualized Perioperative Care
After Surgery
Conclusion
References
17 - Airway Management in Special Situations
Management of Unanticipated Difficult Airway
Cancer Airway Assessment
Limits of Diagnostic Imaging Studies for Cancer Airway Evaluation
Guidelines and Cognitive Aids in Managing Difficult Airways
Training and Education in Cancer Airway Management
Human Factor in Airway Management
Principles and Strategies of Managing an Unexpected Difficult Cancer Airway
Techniques and Tools for Management of the Difficult Cancer Airway
Extubation of the Difficult Airway
Current Guidelines for Managing Extubation Failure or At-Risk Extubation
Recognizing the Risk Factors Leading to Extubation Failure
General Strategies for Extubation of the Difficult Airway
Awake Versus Deep Extubation
Strategies for Extubating the Difficult Airway
Management of Upper Airway Bleeding
Conclusion
References
18 - Procedural Care of the Adult Cancer Patient Outside of the Operating Room
Introduction
Practice Guidelines
Screening
Scheduling
Anesthesia Provider Evaluation
Non-operating Room Anesthesia
Basic Anesthesia Monitoring
Intraprocedural Anesthetic Plan
Positioning
Respiratory Compromise
Post procedure Recovery
Standard I
Standard II
Standard III
Standard IV
Standard V
Conclusion
References
19 - Perioperative Care of the Surgical Patient: Brain
Introduction
Preoperative Assessment
Intraoperative Planning
General Anesthesia for Asleep Craniotomy
Awake Craniotomy
Introduction
Indications
Techniques
Premedications
Preinduction
Induction
Head Fixation
Access and Monitoring
Intraoperative Management
Intraoperative Challenges
Intraoperative Considerations and Management
Vascular Access and Monitoring
Head Pinning and Surgical Positioning
Brain Relaxation and Optimizing Surgical Exposure
Emergence From Anesthesia
Scalp Block
Postoperative Management and Pain Control
Conclusion
References
20 - Anesthesia for Spine Cancer Surgery
Introduction
Surgery for Spinal Metastases
Staging and Scoring Systems
Hematologic Malignancies
Cement Augmentation, Kyphoplasty, Vertebroplasty
Stereotactic Radiosurgery and Intensity-Modulated Radiotherapy
Separation Surgery
Decompressive and Stabilization Surgery
En Bloc Resection
Prognosis
Anesthetic Considerations
Preoperative Evaluation
Anesthetic Technique
Airway Management
Positioning
Bleeding
Postoperative Considerations
Venous Thromboembolism
Conclusion
References
21 - Anesthesia for Head and Neck Cancer Surgeries
Introduction
Cancer Surgery
Neck Dissection
Reconstructive Procedures
Applied Anatomy
Preoperative Assessment and Optimization
Airway Assessment
Primary Tumor
Facial Defects
Trismus
Ankyloglossia
Dentition
Selection of the Nostril for Tracheal Intubation
Tracheomalacia
Airway Imaging
Diagnostic Airway Procedures
Anemia
Nutrition
Previous Cancer Therapies
Previous Surgery
Radiation
Chemotherapy
Geriatric Issues
Effect of Tobacco and Smoking
Preoperative Pain Assessment and Management
Patient Education and Counseling
Intraoperative Management
Monitoring
Cardiac Output Monitoring
Temperature Monitoring
Periintubation Oxygenation
Preoxygenation
Apneic Oxygenation
Commonly Used Tracheal Tubes
RAE Tubes
Flexometallic Tubes
Electromyographic Tube
Plan for Airway Management—Awake Versus Asleep
Tracheostomy Under Local Anesthesia
Awake Tracheal Intubation
Premedication
Sedation
Anesthetizing the Airway
Oxygenation
Types of Awake Tracheal Intubation
i. Intubation With the Flexible Bronchoscope
ii. Awake Video-laryngoscopy
iii. Retrograde Intubation
iv. Blind Nasal Intubation
Tracheal Intubation After General Anesthesia
Fluid Management
Blood Transfusion
Vasopressor Use
Analgesia
Nerve Blocks43,44
Prophylaxis for Postoperative Nausea and Vomiting
Postoperative Airway Management Plan: Tracheostomy Versus Tracheal Tube
Postoperative Management
Monitoring
Airway Management
Sedation
Pain Management
Extubation
Postoperative Nutrition
Enhanced Recovery After Surgery (ERAS)
Postoperative Complications
Airway Complications
Surgical Complications
Troponitis in Head and Neck Cancer Surgery
Care of the Patient With a Tracheostomy
Postoperative Rehabilitation
Special Considerations for Specific Surgeries
Laryngectomy
Preoperative Considerations
Intraoperative Considerations
Postoperative Considerations
Endolaryngeal Vocal Fold Surgery
Airway Management and Ventilation
Thyroid Surgery
Airway Assessment
Postoperative Considerations
Microvascular Surgery
Preoperative Considerations
Intraoperative Considerations
Postoperative Considerations
Surgeries Requiring Neuromuscular Monitoring
Thyroid Surgery
Parotid Surgery
Transoral Robotic Surgeries (TORS)
References
22 - Perioperative Care of the Surgical Patient: Heart, Lung, and Mediastinum Procedures
Anesthetic Management for Thoracic Procedures in the Cancer Patient
Oncologic Management of Lung Cancer
Preoperative Evaluation
Intraoperative Management
Monitoring
Airway Management
Induction and Maintenance
Pain Management
Ventilation Strategies
Fluid Management
Special Considerations
Minimally Invasive/Robotic-Assisted Thoracic Surgery
Postoperative Management
Mediastinal Masses
Introduction
Normal Anatomy and Pathology
Incidence and Location
Clinical Presentation
Preoperative Evaluation
Diagnostic Techniques and Anesthetic Implications
Anesthetic Management
Special Considerations
Anesthesia for Mediastinoscopy
Superior Vena Cava Syndrome
Myasthenia Gravis
Perioperative Considerations
Conclusion
References
23 - Perioperative Care of the Cancer Patient: Breast Procedures
Background
Risk Factors
Screening
Staging
Types of Breast Cancers
Prognosis
Future Aims in the Approach to Breast Cancer
Management of the Breast Cancer Patient
Nonsurgical Management of Breast Cancer
Systemic Treatment
Neoadjuvant Chemotherapy
Adjuvant Chemotherapy
HER2-Directed Therapy
Endocrine Therapy
Surgical Management of Breast Cancer
Breast-conserving Therapy
Radiotherapy in Breast-Conserving Therapy
Mastectomy
Role of Postmastectomy Radiotherapy
Axillary Staging
Plastic and Reconstructive Surgery
Postmastectomy Breast Reconstruction
Types of Breast Reconstruction Modalities
Prosthetic-based Breast Reconstruction
Immediate, Single-stage Implant Reconstruction
Immediate or Delayed Two-staged Implant Reconstruction
Mixed Implant and Autologous Reconstruction
Tissue Expander Expansion
Types of Implants
Autologous Breast Reconstruction
Techniques
Nipple Reconstruction
Advantages and Disadvantages of Modalities
Special Considerations
Radiation Therapy
Breast Implant-associated Anaplastic Large Cell Lymphoma
Patient-reported Outcomes
Anesthesia for Breast Surgery
Perioperative Anesthesia Considerations for Breast Cancer Surgery
Anesthesia and Type of Breast Cancer Surgery
Neoadjuvant Chemotherapy
Enhanced Recovery after Surgery (ERAS) for Breast Procedures
Pain, Regional Anesthesia, and Breast Surgery
Paravertebral Blocks
“Novel” Plane Blocks
Blue Dye Reactions
Anesthesia and Breast Cancer Recurrence
Conclusions
References
24 - Intraoperative Care of the Surgical Patient: Upper Gastrointestinal Cancers
Introduction
Chemotherapeutic Toxicity
Esophageal Cancer
Epidemiology
Diagnosis and Staging
Treatment
Endoscopic Ultrasound
Surgical Treatment and Intraoperative Considerations
Surgical Candidacy
Relevant Anatomy
Type of Surgery
Intraoperative Considerations
Induction and Airway Management
Maintenance of Anesthesia
Intravenous Access
Fluid
Vasopressor Use
Pain Management
Emergence
Intraoperative Complications
Prevention of Pulmonary Complications
Enhanced Recovery After Surgery Protocols
Prevention of Atrial Fibrillation
Repair of Tracheoesophageal Fistula
Gastric Cancer
Intraoperative Management
Cancers of the Duodenum
Cancers of the Oropharynx
Other Upper Gastrointestinal Tumors
Conclusion
References
25 - Perioperative Care of the Colorectal Cancer Patient
Introduction
Presentation, Diagnosis, and Treatment
Perioperative Considerations of Neoadjuvant Chemotherapy
Anemia and Perioperative Blood Transfusion
Preoperative Exercise and Prehabilitation
Enhanced Recovery After Surgery (ERAS) Protocols
Operative Risk Assessment
Surgery—Open, Laparoscopic-Assisted, or Robotic-Assisted Laparoscopic Approaches
Choice of Anesthesia and Analgesia and Effect on Clinical Outcomes
Propofol Versus Inhalational Anesthesia
Epidural Analgesia
Fascial Plane Regional Anesthesia
Multimodal Analgesia
Neuromuscular Blocking Agents
Dexamethasone
Intravenous Lidocaine
NSAIDs
Effect of Anesthetic and Analgesic Agents on Cancer Recurrence
References
26 - Perioperative Care of the Surgical Patient: Genitourinary Cancers
Introduction
Perioperative Assessment and Optimization
Enhanced Recovery and Postoperative Care
Common Complications and Causes for Readmission
Thromboprophylaxis
Opioid-Sparing Surgery
Conclusion
References
27 - Perioperative Care of the Surgical Cancer Patient: Gynecologic Cancers
Introduction
Ovarian Cancer
Cervical Cancer
Endometrial Carcinoma
Vulval Cancer
Perioperative Considerations
Preoperative
Radiotherapy
Prehabilitation
Preoperative Fasting
Venous Thromboembolism Prophylaxis
Surgical Site Infection Prevention
Intraoperative Considerations
Minimally Invasive Surgery
Anesthetic Technique
Fluid Management
Goal-Directed Fluid Therapy
Nausea and Vomiting Prevention
Drains and Tubes
Hypothermia Prevention
Postoperative Considerations
Venous Thromboembolism Prophylaxis
Postoperative Nutrition
Postoperative Ileus Prevention
Postoperative Pain Management
Particular Considerations
Conclusion
References
28 - Anesthesiology and Perioperative Management of Patients Presenting for Surgical Excision of Endocrine Tumors
General Introduction
Perioperative Management of Thyroid Tumor Resection
Epidemiology
Preoperative Management
Interpretation of the Thyroid Function Test
Euthyroid Sick Syndrome
Corticosteroids
Intraoperative Management
Recurrent Laryngeal Nerve Damage
Cervical Hematoma
Hypocalcemia
Postoperative Management
Pheochromocytoma
Epidemiology
Preoperative Management
Preoperative Medical Management
Alpha-adrenoceptor Blockade
Beta-adrenoceptor Blockade
Vascular Expansion
Intraoperative Management
Surgical Technique
Common Intraoperative Issues
Hypertension
Tachyarrhythmias
Hypotension
Postoperative Management
Cushing’s Syndrome
Introduction
Epidemiology
Twenty-four Hours Urinary Free Cortisol
Late-night Salivary Cortisol
Dexamethasone Suppression Test24
Low-Dose Dexamethasone Suppression Test
High-Dose Dexamethasone Suppression Test
Preoperative Management
Intraoperative Management
Surgical Technique
Postoperative Management
Venous Thromboembolism
Respiratory Depression
Diabetes Insipidus
Hypoglycemia
Electrolyte Abnormalities
Adrenal Insufficiency
Nelson’s Syndrome
Carcinoid Syndrome
Carcinoid Syndrome: Signs and Symptoms33
Preoperative Management
Intraoperative Management
Postoperative Management
Pituitary Adenomas
Definitions
Epidemiology
Preoperative Management
Intraoperative Management
Surgical Technique
Postoperative Management
Vascular Damage
Transient Diabetes Insipidus
Airway Obstruction
Intracranial Bleeding
References
29 - Anesthesia and Surgery for Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Introduction
Epidemiology and Cancer Subtypes
Strategy in Cytoreductive Surgery and HIPEC
Sugarbaker’s Five Peritonectomy Procedures
Completeness of Cytoreduction Score
HIPEC Rationale
The Dedrick Diffusion Model
Techniques of HIPEC
Coliseum Technique
Closed Technique
PIPAC
Chemotherapeutic Agents Employed During HIPEC
Conduct of Anesthesia for HIPEC
Preoperative Assessment
Preoperative Assessment and Optimization
Intraoperative Management
Fluid Management
Thermoregulation
Analgesia
Postoperative Management
Conclusion
References
30 - Perioperative Care: Sarcoma and Melanoma
Perioperative Care: Sarcoma
Introduction
General Principles
Histology
Natural History and Prognosis
Management
Neoadjuvant Therapy
Neoadjuvant Chemotherapy
Neoadjuvant Radiotherapy
Targeted Therapies
Preoperative Care
Prehabilitation
Intraoperative Considerations
Retroperitoneal
Histologic Tailored Surgery
Isolated Limb Infusion/Perfusion
Intraoperative Blood Loss
Bypass
Postoperative Care
Special Considerations
Enhanced Recovery Programs
Extremity Surgery
Thromboprophylaxis
Pain Control
Conclusion
Perioperative Care: Melanoma
Introduction
General Principles
Preoperative Workup
Surgical Principles for the Management of Cutaneous Melanoma
Intraoperative Considerations
Isolated Limb Infusion/Perfusion
Surgery for “Immune Escape” Lesions
Systemic Therapy
Immunotherapy
Targeted Therapy
Neoadjuvant Therapy
Beta Blockade
Conclusion
References
31 - Perioperative Care of the Surgical Patient: Bone and Soft Tissue Tumors
Introduction
Oncoanesthesia and Some of the Crucial Steps for Better Perioperative Outcomes
Preoperative Evaluation
Physical Examination
Selecting an Anesthetic Technique
Anesthetic Maintenance
Regional Anesthesia
Orthopedic Cancers
Sarcomas
Clinical Presentation and Diagnosis
Treatment
Perfusion of Extremities
Bone Tumors
Regional Anesthesia and Cancer
Anesthetic Agents and Impact on the Immune System
Volatile Anesthetics
Intravenous Anesthetics
Opioids
Nonsteroidal Antiinflammatory Drugs
Local Anesthetics
Conclusions
References
32 - Perioperative Care of the Surgical Patient: Reconstructive Surgery
Applied Surgical, Pathologic, and Physiologic Concepts
General
Surgical Concepts
Pathologic Concepts Associated With Free Flap Complications: The Endothelial Glycocalyx, Inflammation, and Ischemic Reperf ...
Physiology of Flap Perfusion and Relevant Perioperative Factors
Strategies for Hemodynamic Optimization
Preoperative Carbohydrate Drinks
Goal-Directed Therapy
Choice of Intravenous Fluid Therapy
Vasoactive and Inotropic Drugs
Therapies Targeting the Endothelial Glycocalyx
Perioperative Considerations for Microvascular Free Flap Transfer Procedures
Perioperative Considerations
Identification and Optimization of Risk Factors Associated With Poor Flap Outcomes
Smoking and Nicotine Replacement Therapy
Diabetes Mellitus and HbA1c
Radiotherapy
Anemia
Malnutrition
Autologous Breast Reconstruction
General
Comorbidities
Obesity
Type of Reconstruction
Adjuvant Therapies
Radiotherapy
Radiation-Induced Heart Injury
Hormone Inhibitors
Chemotherapy-Induced Cardiac Toxicity
Enhanced Recovery After Surgery for Autologous Breast Reconstruction
Head and Neck Cancer Resection With Immediate Flap Reconstruction
General
Etiology
Demographic
Commonly Used Free Flaps in HN Reconstruction
Airway Planning and Postoperative Destination
Analgesia
Feeding
Postoperative Delirium
Patient Positioning and Pressure Care
Free Flap Breast Reconstruction
HN Reconstruction
Monitoring
Anesthetic Maintenance
Multimodal Analgesia
Lignocaine Infusions
Nonsteroidal Antiinflammatory Drugs and Cyclooxygenase-2 Inhibitors
Gabapentinoids
Regional Anesthetic Techniques for Autologous Breast Reconstruction
Epidural
Transverse Abdominis Plane Blocks and Rectus Sheath Block
Postoperative Nausea and Vomiting
Temperature Management
Venous Thromboembolism Prevention
Antibiotic Regimen
Postoperative Considerations
Anesthetic Emergence
Optimization of Flap Perfusion
Postoperative Flap Monitoring
Pulmonary Function and Early Mobilization
Conclusion
References
33 - Perioperative Care of the Surgical Patient: Surgical Emergencies in Cancer
Background
Triage
Risk Stratification
Care Processes to Improve Patient Outcomes
Optimizing Patient Condition
Target Blood Pressure in Patients Undergoing Emergency Surgery
Preoperative Airway Assessment
Airway Management in the Emergency Onco-surgical Patient
Airway Emergencies in Cancer Patients—Anesthetic Management
Malignant Central Airway Obstruction
Carotid Blowout Syndrome
Intra-abdominal and Intra-thoracic Surgeries
Anesthetic Management of Patients With Anastomotic Leaks Following Gastrointestinal Surgeries
Management of Patients With Emergency Colorectal Surgeries
Management of Massive Transfusion in Patients Undergoing Emergency Oncosurgeries
Raised Intracranial Pressure
Spinal Cord Compression
Summary
Acknowledgment
References
34 - Palliative Surgery in Cancer Patients
Introduction
Preoperative Assessment
Interventional Radiology
Esophagus
Stomach
Pancreas
Biliary Tract/Liver
Small and Large Bowel and Rectum
Brain and Vertebral Column
Head and Neck
Pleura, Chest Wall, Lung, and Mediastinum
Breast
Thyroid Gland
Adrenal Gland
Urology
Gynecology
Orthopedics
Conclusions
Key Points
References
35 - Frailty in the Perioperative Setting for Cancer Patients
Introduction
Frailty in Cancer Patients
Definition, Conceptualization, and Prevalence of Frailty
Sex Differences in Frailty
Frailty in Predicting Cancer and Surgical Outcomes
Principles of Frailty and Geriatric Syndromes
Dementia and Delirium
Falls
Depression and Anxiety
Polypharmacy
Malnutrition
Comprehensive Geriatric Assessment
Frailty Screening and Measurement Tools
Fried Criteria
Frailty Index
Modified Frailty Index
Geriatric 8
Vulnerable Elder Survey
Nutrition and How It Impacts on Surgery
Anorexia, Cancer Cachexia, and Sarcopenia
Sarcopenic Obesity and the Obesity Survival Paradox
Nutrition Support Before and After Cancer Surgery
Perioperative Care for Older Cancer Patients: Clinical Implications
Conclusion
References
36 - Delivering Perioperative Care for Older Patients Undergoing Cancer Surgery
Introduction
Patient Assessment
Core Components of Perioperative Care for Older Patients Undergoing Cancer Surgery
Preoperative Care for Older Patients Undergoing Cancer Surgery
Assessment of Frailty
Assessment of Comorbidities
Assessment of Geriatric Syndromes
Assessment of Functional Capacity
Assessment of Psychological Factors and Social Situation
Optimization
Optimization of Medical Comorbidities
Comprehensive Medication Review
Optimizing Geriatric Syndromes
Optimizing Malnutrition
Optimizing Psychosocial Factors and Lifestyle Risk Factors
Optimizing Functional Reserve
Shared Decision-Making
Advanced Care Planning
Postoperative Care for Older Patients Undergoing Cancer Surgery
Prevention and Treatment of Medical Complications
Optimization and Recovery to Functional Baseline
Discharge Planning
Current Models of Perioperative Care for Older People Undergoing Cancer Surgery
Traditional Surgical Model
Enhanced Recovery After Surgery (ERAS) Programs
Anesthetist-Led Model
Hospitalist-Led Model
Geriatrician-Led Model
References
Section 4: Acute Postoperative and
Intensive Care of the Cancer Patient
37 - Special Considerations in the Postoperative Care of the Cancer Patient
Nutrition
Functional Status
Prehabilitation
Wound Healing
Adjuvant Therapy
Radiation Therapy
Chemotherapy
Pain Management
Postoperative Nausea and Vomiting Prevention
Thromboembolic Prophylaxis
Postoperative Quality of Life in Cancer Patients
References
38 - Early Warning and Rapid Response Systems
Introduction
The Rapid Response System
Composition
Evidence
Oncology-Related Issues
Future Directions
Summary
References
39 - Intensive Care Considerations of the Cancer Patient
The Surgical Oncologic Patient
Burden of Disease
Surgical Oncology Critical Care Outcomes
ICU Resource Allocation and Admission Prioritization
Common Factors Affecting Patients Coming to the ICU
Neutropenia and Immunosuppression
Thrombocytopenia
Prothrombotic States
Coagulopathy
Malnutrition
Patients Requiring Monitoring
Neurologic
ENT-Upper Airway
Cardiac
Plastics Flaps
Postoperative Respiratory Failure
Preoperative Risk Stratification
Prevention
Intraoperative Respiratory Failure Risk Reduction
Fio2
Positive-End Expiratory Pressures
Low Tidal Volume
Prevention of Postoperative Pneumonia
Fluid Administration
Postoperative Considerations
High-Flow Nasal Cannula
Non-invasive Positive Pressure Ventilation
References
40 - The Challenges of Novel Therapies in the Care of the Critically Ill Cancer Patient
Basic Sciences
Cell Proliferation
Angiogenesis
The Immune Response
Adoptive Cell Transfer
Novel Cancer Therapies
Targeted Therapies
Immunotherapies: Monoclonal Antibodies
Immune Checkpoint Inhibitors
Cellular Immunotherapy
Novel Agent Toxicity
Cardiovascular Sequelae of VEGF Inhibition
Immune-Related Adverse Events
Cytokine Release Syndrome
Immune Effector Cell-Associated Neurotoxicity Syndrome
Hemophagocytic Lymphohistiocytosis
Conclusion
References
Section 5: Pain and Palliative/Integrative
Medicine
41 - Acute Postsurgical Pain Management in Patients with Cancer
Introduction
Postoperative Pain Management in Cancer Patients
Various Analgesic Modalities
Oral Analgesics
Parenteral Analgesia
Neuraxial Modalities
Epidural Analgesia
Spinal Analgesia
Regional Anesthesia
Side Effects and Complications
Postoperative and Postdischarge Follow-up
Conclusion
References
42 - Chronic and Interventional Pain Management in Patients With Cancer
Introduction
Evaluating the Patient With Cancer-Related Pain
Medical History and Physical Examination
Radiologic and Electrophysiologic Studies
Pharmacologic Management of Cancer-Related Pain
Acetaminophen
Nonsteroidal Antiinflammatory Drugs(NSAIDs)
Opioids
Codeine
Tramadol
Tapentadol
Morphine
Oxycodone
Hydromorphone
Methadone
Fentanyl
Anticonvulsants
Antidepressants
Corticosteroids
Muscle Relaxants
Local Anesthetics
Alpha-2 Agonist
NMDA Antagonists
Interventional Management of Cancer Pain
Epidural Steroidal Injections
Neurolytic Procedures
Vertebral Augmentation
Spinal Cord Stimulation and Dorsal Root Ganglion Stimulation
Intrathecal Drug Delivery System
Cordotomy
Scrambler Therapy
Conclusion
References
43 - Rehabilitation, Palliative Care, and Integrative Medicine Interventions in Cancer
Rehabilitation Interventions in Patients With Cancer
Introduction
Multi-disciplinary Assessment
Types of Rehabilitation
Indications and Benefit of Rehabilitation
Palliative Care Interventions in Patients With Cancer
Introduction
Benefits of Palliative Care Referral in Patients With Cancer
Delivery of Palliative Care
Pain Management in Patients With Advanced Cancer in a Palliative Care Setting
Integrative Medicine Interventions in Patients With Cancer
References
44 - Integrating Rehabilitative and Palliative Care Principles Within Acute Care Practice
Introduction
Palliative Care
Palliative Care in Acute Care Settings
Delivery of Palliative Care
Goals of Palliative Care in the Acute Care Setting
What Is Delivered Within a Palliative Care Pathway?
Barriers to Palliative Care in the Acute Setting
The Hospital Environment
Reduced Awareness and Insufficient Knowledge
Disease Trajectory
Lack of Advance Care Planning
Rehabilitation
What is Rehabilitation?
Why Do We Need Rehabilitation in an Acute Care Setting?
Goals of Early Rehabilitation
Rehabilitation Interventions
Therapeutic Exercises
Positioning
Pulmonary Rehabilitation
Intubated Patients
Nonintubated Patients
Mobilization of the Patient
Speech and Swallowing Rehabilitation
Conclusion
References
Section 6: Perioperative/Periprocedural
Care of the Pediatric Patient With Cancer
45 - Overview of Pediatric Cancers
Introduction
Acute Lymphoblastic Leukemia
Acute Myeloid Leukemia
Pediatric Lymphomas
Bone Sarcomas
Rhabdomyosarcoma
Solid-Organ Tumors: Wilms Tumor and Hepatoblastoma
Central Nervous System Tumors
Preoperative Care for the Pediatric Patient With Cancer
The Role of Pediatric Critical Care Unit in Preoperative Care
References
46 - Preoperative Assessment of the Pediatric Patient With Cancer
Introduction
Neurologic Evaluation
Cardiac Evaluation
Pulmonary Evaluation
Gastrointestinal Evaluation
Hepatic/Renal Evaluation
Endocrine Evaluation
Hematologic Evaluation
Pain Evaluation
Preoperative Laboratory Testing
Fasting Guidelines
Parental Concerns
Anesthetic-Related Neurotoxicity
Parental Presence during Induction
Special Considerations
The Difficult Airway
Syndromes Related to Cancer
Vascular Access
Conclusion
References
47 - Intraoperative Management: Considerations for Specific Procedures in Children with Cancer
Anesthetic Management of the Child with an Anterior Mediastinal Mass
Anesthetic Management
Summary
Anesthesia for Pediatric Radiotherapy
Airway Management
General Anesthesia versus Conscious Sedation
Medications
Propofol
Volatile Anesthetics
Dexmedetomidine
Ketamine
Midazolam
Chloral Hydrate
Complications
Neurotoxicity of Anesthetic Agents
Summary
Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy
References
48 - General Principles for Intensive Care Management of Pediatric Patients With Cancer
Introduction/Overview
Airway
Breathing
Mechanical Ventilation
Noninvasive Ventilation
High-Flow Nasal Cannula Therapy
Pulmonary Hygiene
Circulation
Pericardial and Pleural Effusions
Systemic Inflammatory Response Syndrome
Fluid Management
Inotropic Support
Pain Management
Epidural/Regional Analgesia
Patient-Controlled Analgesia
Opioids
Ketamine and Dexmedetomidine
Nerve Pain
References
49 - Anesthesia for Procedures Outside of the Operating Room
Introduction
Locations Requiring NORA
Challenges Associated With NORA
Patient Factors
Environment, Equipment, and Staffing Factors
Environmental Concerns
Equipment Concerns
Staffing Concerns
Procedural Factors
Who Should be Administering Sedation and Anesthesia?
The Roles, Responsibilities, and Training Requirements for Anesthesiologists and Assistants
Patient Evaluation, Preparation, and Preprocedure Checklist
Minimum Monitoring Standards
Anesthesia Techniques
Inhalational Technique
Total Intravenous Anesthesia
Complications
Postprocedural Care
Conclusion and Key Messages
References
50 - Do Not Resuscitate and the Terminally Ill Child
Introduction
Decision-Making in Pediatrics
Goals of Care
Concurrent Care
Communication
Family Meetings
Tools for the Providers
Advanced Care Planning
Code Status
Palliative Procedures
Perioperative DNR Orders
Care at End of Life
References
51 - Chronic Pain and Palliative Care in the Pediatric Patient
Introduction
Pain Presentations
Types of Pain
Chronic Pain Etiologies
Chronic Pain Evaluation
Chronic Pain Management
General Strategy
Nonpharmacologic Management
Pharmacologic Management
Procedural Anesthesia/Analgesia
Chronic Pain Sequelae
Palliative Care
References
52 - Special Considerations for Intensive Care Management of Pediatric Patients With Cancer
Neurologic Diagnoses in the Pediatric Oncologic Critical Care Patient
Disorders of Sodium Homeostasis Following Neurosurgery
Central Diabetes Insipidus
Syndrome of Inappropriate Antidiuretic Hormone
Cerebral Salt Wasting
Posterior Reversible Encephalopathy Syndrome
Convection-Enhanced Delivery
Anterior Mediastinal Masses
Metastatic Lung Disease
Intraabdominal Tumors
Neuroblastoma
Immunotherapy for Neuroblastoma
Wilms Tumor
Transfusion Medicine
Enhanced Recovery After Surgery
References
Section 7: Value Proposition and Research
in Perioperative Cancer Care
53 - Value Proposition in Cancer Care: Quantifying Patient-Centered Value in a Comprehensive Cancer Care Center
Radar Plots
A Comprehensive Value Equation for a Comprehensive Cancer Center
Defining Quality and Safety: Outcomes That Matter to Patients
The Full Value Equation
Defining the Value Equation
The Numerator: Quality
The Numerator: Safety/Harm
The Numerator: Accounting for All Three Tiers of Value
Cost
The Value Equation: Summary
Collecting Data
Patient Engagement
Supportive Leadership
Visualizing and Comparing Value
Radar Value Plots
The Value Plot in Action
A Note About QALYs
The Value Equation Payoff
Institutional Value Improvement
Shared Decision-Making and Goal-Concordant Care Delivery
References
54 - Enhanced Surgical Recovery and Cancer
Introduction
Preoperative Preparation
Advanced Care Planning
Education
Prehabilitation
Anemia Management
Nutrition
Optimizing the Nutritional Status of a Cancer Patient Prior to Surgery
Intraoperative Management
Postoperative Nausea and Vomiting Prophylaxis
Fluid Management and Hemodynamic Optimization
Multimodal Pain Management
Avoiding Hypothermia
Postoperative Care
Pain Management Maintenance
Postsurgical Complications and Return to Intended Oncologic Therapies
Health-Related Quality of Life Assessment
Conclusion
References
55 - Symptom Assessment, Patient-Reported Outcomes, and Quality of Life Considerations in Perioperative Care for Patients ...
Introduction
Defining PRO concepts
Ideal PRO Instruments
PRO Instrument Development
Similarities and Differences Between Symptoms and QoL as Concepts
Clinical Research on Pro Application in Perioperative Care
Ground Knowledge From PROs
Challenges and Opportunities
Clinical Research Outcomes
Methodologies for Applying Pro Measures in Perioperative Care
Considerations in Selecting Assessment Tools
Assessment Schedules
Cutoff Points as Thresholds to Trigger Intervention
Examples of Using PROs to Define Recovery After Thoracic Surgery
Examples of Using PROs to Evaluate Pathway and Procedure-Specific Benefits After Gynecologic Surgery
Examples of Using PROs to Improve Postoperative Care
Future Considerations Regarding the Use of PROs in Perioperative Care
Conclusion
References
56 - 
Shared Decision-Making and Advance Care Planning in the Cancer Care Journey
Introduction
What Is Shared Decision-Making?
Why Is Shared Decision-Making Needed?
What Elements Are Required to Make Shared Decision-Making Successful?
Individual and Societal Advantages of Shared Decision-Making
How Does Advance Care Planning Fit Into Shared Decision-Making?
Conclusion and Key Points
References
57 - Ethics in Cancer Care Delivery—Do Not Resuscitate
Introduction
Cardiopulmonary Resuscitation
Law, Regulations, and Guidelines
Intraoperative CPR Outcomes
Outcomes of CPR in Cancer Patients
Outcomes of Palliative and Rescue Surgery in Cancer Patients
Outcomes of Patients with DNR Orders
Ethical Considerations on Sustaining or Withholding DNR Status During Palliative Surgical Procedures
Advance Care Planning—Communicating and Defining Goals of Care
Conclusion
References
58 - Economics of Cancer Care Delivery: Opportunities and Challenges
Introduction
Economics of Cancer Care, 2019
Cost of Treatments
Magnitude of the Issue
Medically Induced Bankruptcy
Financial Distress and Toxicity
Current Strategies to Reduce Cost
The Ultimate Solution to Reduce Costs
Health Plan Efforts in Wellness
Strategies in Benefit Design to Lower Costs
Alternate Payment Models
The Uninsured
Conclusion
References
59 - The Costs of Postoperative Complications After Major Abdominal Surgery: Opportunities and Challenges
Key Points
Introduction
Rectal Resection Surgery
Colonic Resection Surgery
Liver Resection
Pancreatic Resection
Discussion
Conclusion
References
60 - Research in Perioperative Care of the Cancer Patient: Opportunities and Challenges
Basic Science and Translational Studies
Clinical Endpoints
Retrospective and Population Database Studies
Randomized Controlled Trials
Conclusion
Key Points
References
61 - Big Data, Advances in Computational Sciences, and Oncology Care
Little Data to Big Data
NoSQL Technology
Computational Advances
Cloud Computing
Analytics and Visualization
Augmented Decision Support
Machine Learning and Artificial Intelligence
Neural Networks and Deep Learning
Genomic Data
Population Health
Impact on Anesthesia
Conclusions
References
62 - The MD Anderson Cancer Center Moon Shots Program®: A Global Priority
Introduction
Lung Cancer Moon Shot: Smoking Cessation Initiatives
Smoking Cessation Solutions
HPV Cancer Moon Shot: The Global Burden of HPV-Associated Cancers
HPV Vaccine Development, Evolution, and Recommendations
Barriers to Implementation of HPV Vaccination
Global Examples of Vaccine Efficacy/Effectiveness and Success in Overcoming Barriers
How the Cancer Moon Shots Program® Has Worked With Policy Makers and Other Stakeholders in Promoting Vaccine Rates in Texa ...
Pancreatic Cancer Moon Shot: The Quest for Early Detection
Pancreatic Cancer High-Risk Clinic
Blood-Based Biomarkers
Imaging Tools for Early Detection
Conclusion
References
Index
IBC