Textbook of Onco-Anesthesiology

Preface
Contents
Editors and Contributors
About the Editors
Section Editors
Contributors
Part I: Introduction
1: Need for Onco-Anesthesia as Super Specialty
1.1 Introduction
1.2 The Need
1.3 Onco-Anesthesiology as a Separate Specialty: Present Scenario
1.4 At All India Institute of Medical Sciences (AIIMS)
1.5 Future Prospects
1.6 Summary
References
2: Epidemiology of Cancer
2.1 Introduction
2.2 Definition of Cancer Epidemiology
2.3 Role of Cancer Epidemiology in Healthcare Improvement
2.4 Molecular Epidemiology
2.5 Sources of Cancer Data
2.6 Cancer Statistics
2.7 Conclusion
References
3: Anesthesia and Cancer Recurrence
3.1 Introduction
3.2 Cancer Biology
3.3 Effect of Surgery on Cancer
3.4 Effects of Anesthetic Techniques and Drugs on Cancer
3.5 General Factors
3.6 Specific Agents and Techniques Used in Anesthesia and Their Influence on Cancer
3.7 Intravenous Anesthetic Agents
3.8 Regional Anesthesia
References
Part II: Basics of Onco-Anaesthesiology
4: Anaesthetic Implications of Chemotherapy and Radiotherapy
4.1 Introduction
4.2 Concerns in the Preoperative Period Due to Cancer Therapy
4.3 Basic Principles of Chemotherapy
4.4 Chemotherapeutic Agents
4.4.1 Anti-tumour Antibiotics
4.4.1.1 Anthracyclines
4.4.1.2 Bleomycin
4.4.1.3 Mitomycin C
4.4.2 Alkylating Agents
4.4.3 Anti-metabolites
4.4.3.1 Methotrexate
4.4.3.2 5-Fluorouracil
4.4.4 Cisplatin and Analogues
4.4.5 Anti-microtubule Agents
4.4.5.1 Vinca Alkaloids: Vincristine, Vinblastine
4.4.5.2 Taxanes: Paclitaxel, Docetaxel
4.4.6 Topoisomerase II Inhibitors: Etoposide, Teniposide
4.5 Systems Wise Approach to Pre-anaesthetic Assessment and Management
4.5.1 Cardiovascular System
4.5.1.1 Preoperative Assessment
4.5.1.2 Perioperative Management
4.5.2 Respiratory System
4.5.2.1 Preoperative Evaluation
4.5.3 Gastrointestinal System
4.5.4 Renal System
4.5.4.1 Perioperative Implications
4.5.5 Nervous System
4.5.6 Haematopoetic System
4.6 Anaesthetic Effects of Radiation Therapy
4.6.1 Basic Principles of Radiation Therapy (RT)
4.6.1.1 Adverse Effects of Radiation [57, 58]
4.6.1.2 Airway Changes Due to Radiation [59, 60]
4.6.1.3 Pulmonary Effects of Radiation [61, 62]
4.6.1.4 Cardiac Effects of Radiotherapy [63, 64]
4.7 Summary
References
5: Preoperative Assessment and Optimization of the Cancer Patient for Onco-Surgery
5.1 Introduction
5.2 Global Assessment of the Cancer Patient
5.2.1 Cardiovascular Assessment
5.2.2 Pulmonary Assessment
5.2.3 Neurological Assessment
5.2.4 Renal Assessment
5.2.5 Airway Assessment
5.3 Risk Stratification and Prognostication
5.3.1 Prehabilitation
5.3.1.1 Physical Activity
5.3.1.2 Nutrition
5.3.1.3 Anemia Correction
5.3.1.4 Smoking/Alcohol Cessation
5.3.1.5 Stress Management
5.3.2 Cardiopulmonary Exercise Testing (CPET)
5.4 Summary
References
6: Prehabilitation for Onco-Anesthesiology
6.1 Introduction
6.2 Preoperative Exercise Program
6.2.1 Rationale
6.2.2 Method of Assessing Functional Capacity/Fitness
6.2.3 Exercise Strategies
6.3 Nutritional Support
6.3.1 Nutritional Assessment
6.3.2 Nutrition Goal
6.4 Anemia
6.5 Conclusion
References
7: Airway Management in Cancer Patients
7.1 Introduction
7.2 Reasons for Difficult Airway in Cancer Patients
7.3 Types of Airway Difficulties in Cancer Patients
7.4 Planning Airway Management in Cancer Patients
7.4.1 Airway Assessment of Cancer Patients
7.4.1.1 Focused History
7.4.1.2 Focused General Physical Examination
7.4.1.3 AMF “Line of sight” Airway Examination
7.4.2 Optimization of Areas Deemed “Difficult” During Airway Assessment in Cancer Patients
7.4.3 Review of Surgical Requirements
7.4.4 Means of Maintaining Good Oxygenation
7.4.5 Making Main and Subsidiary Plans
7.5 Summary
References
8: Drugs, Fluids and Cancer
8.1 Introduction
8.2 Effects of Surgery
8.3 Anesthetic Agents
8.4 Analgesics
8.5 Local Anesthetic Agents And Neuro-muscular Blocking Agents
8.6 Effect of Other Perioperative Factors
8.6.1 Hypothermia
8.6.2 Blood Transfusion
8.6.3 Other Perioperative Factors
8.7 Anesthetic Technique
8.7.1 Role of Regional Anesthesia or Analgesia
8.7.2 Propofol Versus Inhalational Anesthesia
8.8 Fluids and Cancer
8.8.1 General Principles
8.8.2 Perioperative Management of Fluids in Cancer Surgeries
8.8.2.1 Preoperative Fluids
Enhanced recovery after surgery
8.8.2.2 Intraoperative Fluids
8.8.2.3 Postoperative Fluids
8.9 Summary
References
Part III: Specialty Anaesthesiology for Cancers
9: Anesthesia for Oral Cancer Surgery
9.1 Introduction
9.2 Applied Anatomy of the Oral Airway
9.3 Oral Cancer Surgery
9.4 Glossectomy
9.5 Mandibulectomy
9.6 Maxillectomy
9.7 Floor of Mouth (FOM) Excision
9.8 Bite Composite Resections
9.9 Concerns for Anesthesia
9.9.1 Airway
9.9.2 Nutrition and Anemia
9.9.3 Effects of Previous Chemotherapy
9.9.4 Comorbidities
9.9.5 Intra-operative Blood Loss
9.9.6 Hypothermia
9.10 Pre-operative Assessment and Optimization
9.10.1 Airway Assessment
9.10.1.1 Facial Defects
9.10.1.2 Evaluation of Trismus
9.10.1.3 Oral Cavity Examination
Size, Site, and Extent of Tumor
Ankyloglossia
The Base of Tongue Involvement
Dentition and Oral Hygiene
9.10.1.4 Intra-nasal Examination
9.10.1.5 Previous Radiation Therapy
9.10.1.6 Role of Imaging and Previous Airway Examination Findings
9.10.1.7 Virtual Endoscopy
9.10.1.8 Previous Awake Airway Assessment Findings
9.10.2 Nutrition and Anemia
9.10.3 Effects of Tobacco Chewing and Smoking
9.10.4 Effect of Chemotherapy
9.10.5 Pre-operative Pain Management
9.11 Intra-operative Management
9.11.1 Pre-medication
9.11.2 Monitoring
9.11.3 Role of Peri-intubation Oxygenation
9.11.4 General Anesthesia
9.11.5 Securing the Airway
9.11.6 Awake Intubation
9.11.6.1 Pre-medication for Awake Intubation
9.11.6.2 Methods of Anesthetizing the Airway for Awake Intubation
9.11.6.3 Types of Awake Intubation
Intubation with using a Flexible Broncoscope (FB)
Retrograde Intubation
Blind Nasal Intubation
Awake Video Laryngoscopy (VL)
Nasal Endotracheal Tubes
9.11.7 General Measures
9.11.8 Fluid Management
9.11.9 Intra-operative Analgesia
9.11.9.1 Nerve Blocks
9.11.10 Intra-operative Airway Management
9.11.10.1 Intra-operative Loss of Airway
9.12 Post-operative Management
9.12.1 Post-operative Airway Management
9.12.1.1 Sedation
9.12.1.2 Humidification
9.12.1.3 Extubation
9.12.1.4 Assessing and Treating Airway Edema
9.12.1.5 Performing Extubation
9.12.1.6 Use of Airway Exchange Catheters
9.12.2 Nutrition
9.12.3 Rehabilitation
9.12.4 Post-operative Pain Management
9.12.5 Enhanced Recovery After Surgery (ERAS)
9.12.6 Post-operative Complications
9.13 Care of the Patient with a Tracheostomy
9.13.1 Daily Checks by Nursing Staff
9.13.2 Humidification
9.13.3 Suctioning
9.13.4 Assessment of a Patient with a Tracheostomy Inwards
9.13.5 Equipment to Be Kept at the Bedside of a Patient with a Tracheostomy
9.13.6 Obstructed Tracheostomy Tube
9.14 Summary
References
10: Anaesthesia for Head and Neck Cancer Surgeries
10.1 Introduction
10.2 Preoperative Assessment
10.2.1 Airway Assessment
10.3 Risk Stratification and Optimization of Comorbidities
10.4 Operative Laryngoscopy and Microlaryngeal Surgery
10.4.1 Airway Concerns for Microlaryngeal Surgery (MLS)
10.4.1.1 Airway Management
10.5 Intraoperative Ventilation Strategies for MLS
10.5.1 MLS Under Conscious Sedation
10.5.2 MLS Under General Anesthesia
10.5.3 General Anesthetic Management for MLS
10.5.4 Anesthesia Induction and Maintenance
10.5.5 Extubation and Emergence from Anesthesia
10.6 Postoperative Airway Problems
10.7 Anaesthetic Management for Laser Airway Surgeries
10.8 Laser Hazards
10.9 Preventing Airway Fires
10.9.1 Airway Fire Management During Laser Surgery
10.10 Anaesthetic Management of Laryngectomy
10.10.1 Intraoperative Management
10.11 Juvenile Nasopharyngeal Angiofibroma (JNA)
10.11.1 Clinical Presentation
10.11.2 Anesthetic Consideration
10.11.3 Preoperative Blood Conservation Strategies
10.11.3.1 Anaesthetic Management
10.11.4 Various Strategies Employed to Decrease Intraoperative Loss
10.11.5 Intracranial Extension of JNA
10.11.6 Extubation of Trachea
10.12 Summary
References
11: Anesthesia for Lung Cancers
11.1 Introduction
11.2 Non-small Cell Lung Cancer (NSCLC)
11.3 Small Cell Lung Cancer (SCLC)
11.4 Carcinoid Tumors
11.5 Pleural Tumors
11.6 Preoperative Assessment
11.6.1 Assessment of Lung Cancer
11.6.2 Assessment of Respiratory Function Before Lung Resection
11.6.2.1 Lung Mechanical Function
11.6.2.2 Parenchymal Lung Function
11.6.2.3 Cardiopulmonary Interaction
11.6.2.4 Ventilation Perfusion Scintigraphy
11.7 Intraoperative Monitoring
11.7.1 Oxygenation
11.7.2 Capnometry
11.7.3 Arterial Line
11.7.4 Central Venous Line
11.7.5 Pulmonary Artery Catheters
11.7.6 Fiberoptic Bronchoscopy
11.7.7 Continuous Spirometry
11.7.8 Transesophageal Echocardiography (TEE)
11.8 Lung Isolation
11.8.1 Double-Lumen Tubes
11.8.1.1 Size Selection
11.8.1.2 DLT Placement Method
11.8.1.3 Right-Sided Double-Lumen Tubes
11.8.2 Bronchial Blockers
11.8.3 Endobronchial Tubes
11.8.4 Difficult Airways and Lung Isolation
11.8.5 Summary
11.9 One-Lung Ventilation
11.9.1 Hypoxic Pulmonary Vasoconstriction (HPV)
11.9.2 Acute Lung Injury
11.9.3 Tidal Volumes
11.9.4 Positive End Expiratory Pressure (PEEP)
11.9.5 Airway Pressures
11.9.6 Alveolar Recruitment Maneuvers (ARM)
11.9.7 Fraction of Inspired Oxygen (FIO2)
11.9.8 Ventilation Mode
11.9.9 Maintenance of Anesthesia
11.9.10 Postoperative Care
11.9.11 Hypoxemia During One-Lung Ventilation
11.10 Intravenous Fluid Management
11.11 Surgical Procedures
11.11.1 Flexible Fiberoptic Bronchoscopy
11.11.2 Rigid Bronchoscopy
11.11.3 Mediastinoscopy
11.11.4 Endobronchial Ultrasound-Guided Biopsy
11.11.5 Minimally Invasive Thoracoscopic Surgery
11.11.6 Robotic-Assisted Thoracic Surgery
11.11.7 Lobectomy
11.11.8 Pneumonectomy
11.11.9 Limited Pulmonary Resections: Segmentectomy and Wedge Resection
11.12 Postoperative Analgesia
11.12.1 Systemic Medications
11.12.1.1 Opioids
11.12.1.2 Non-steroidal Anti-inflammatory Drugs (NSAIDs)
11.12.1.3 Ketamine
11.12.2 Local Anesthetic Drugs and Regional Nerve Blocks
11.12.2.1 Intercostal Nerve Blocks
11.12.2.2 Epidural Analgesia
11.12.2.3 Paravertebral Block
11.12.2.4 Erector Spinae Plane (ESP) Block
11.12.3 Postoperative Pain Management Problems
11.12.3.1 Shoulder Pain
11.12.3.2 Opioid Tolerant Patients
11.12.4 Postoperative Complications
11.12.4.1 Empyema
11.12.4.2 Bronchopleural Fistula
11.12.4.3 Atrial Fibrillation
11.12.4.4 Cardiac Herniation
11.13 Summary
References
12: Anesthesia for Esophageal Cancer Surgeries
12.1 Introduction
12.2 Epidemiology
12.3 Risk Factors and Pathophysiology
12.4 Preoperative Assessment
12.5 Anesthesia Technique
12.6 Monitoring
12.7 Postoperative Course
12.8 Enhanced Recovery After Surgery
12.9 Evolution of Surgical Technique
12.10 Summary
References
13: Autologous Free-Flap Reconstruction After Oncosurgery
13.1 Introduction
13.2 Surgical Concepts
13.3 Pathological Concepts Associated with Free-Flap Complications
13.4 Physiology of Flap Perfusion and Relevant Perioperative Factors
13.5 Strategies for Hemodynamic Optimization
13.5.1 Preoperative Carbohydrate Drinks
13.5.2 Goal-Directed Therapy (GDT)
13.5.3 Vasoactive and Inotropic Drugs
13.5.4 Therapies Targeting the Endothelial Glycocalyx
13.6 Perioperative Considerations for Microvascular Free-Flap Transfer Procedures
13.6.1 Preoperative Considerations: Identification and Optimization of Risk Factors Associated with Poor Flap Outcomes
13.6.1.1 Smoking and Nicotine Replacement Therapy
13.6.1.2 Diabetes Mellitus and HbA1C
13.6.1.3 Radiotherapy
13.6.1.4 Anemia
13.6.1.5 Malnutrition
13.6.1.6 Surgery-Specific Considerations
Autologous Breast Reconstruction
Adjuvant Therapies
Head and Neck Cancer Resection with Immediate Flap Reconstruction
13.6.2 Intraoperative Considerations
13.6.2.1 Patient Positioning and Pressure Care
13.6.2.2 Surgical Equipment
13.6.2.3 Monitoring
13.6.2.4 Anesthetic Maintenance
13.6.2.5 Multimodal Analgesia
13.6.2.6 Postoperative Nausea and Vomiting (PONV)
13.6.2.7 Temperature Management
13.6.2.8 Venous Thromboembolism Prevention
13.6.2.9 Antibiotic Regimen
13.6.3 Postoperative Considerations
13.6.3.1 Anesthetic Emergence
13.6.3.2 Optimization of Flap Perfusion
13.6.3.3 Postoperative Flap Monitoring
13.6.3.4 Pulmonary Function and Early Mobilization
13.7 Summary
References
14: Anesthesia for Gastrointestinal Cancer Surgeries
14.1 Introduction
14.2 Overview of Preoperative Assessment, Anesthesia, and Pain Management for Bowel Surgery
14.3 Anesthesia for Gastric Cancers
14.4 Anesthesia for Cancer of the Small Intestine
14.5 Carcinoma of the Large Intestine
14.6 Colon Cancers
14.7 Carcinoma Rectum
14.8 Summary
References
15: Anesthesia for Hepatobiliary Cancers
15.1 Introduction
15.2 Preoperative Evaluation
15.3 Preoperative Holding Area
15.4 Intraoperative Management
15.5 Pain Management
15.5.1 Acetaminophen
15.5.2 Nonsteroidal Anti-inflammatory Drugs
15.5.3 Opioids
15.6 Summary
References
16: Anaesthesia for Breast Onco-surgeries and Reconstruction
16.1 Introduction
16.2 Anatomy
16.3 Types of Breast Cancer Surgery
16.3.1 Mastectomy
16.3.2 Wide Local Excision and Lumpectomy
16.3.3 Sentinel Lymph Node Biopsy
16.3.4 Axillary Dissection
16.4 Types of Breast Reconstructive Surgery
16.4.1 Implant-Based Reconstruction
16.4.2 Flap-Based Reconstruction
16.5 Preoperative Assessment
16.5.1 General Consideration
16.5.2 Anxiety and Premedication
16.5.3 Neoadjuvant Therapy Consideration: Chemotherapy
16.5.4 Neoadjuvant Therapy Consideration: Radiotherapy
16.6 Intraoperative Care
16.7 General Anaesthesia
16.7.1 Positioning
16.8 Analgesia
16.9 Regional Anaesthesia and Analgesia
16.9.1 Local Anaesthetic Infiltration
16.9.2 Pecs Block
16.9.3 Pecs Block Supplementation
16.9.3.1 Serratus Anterior Block
16.9.3.2 Transversus Thoracic Plane Block
16.9.4 Paravertebral Blockade
16.9.5 Thoracic Epidural
16.10 Systemic Analgesia
16.10.1 Opioids
16.10.2 Paracetamol and NSAIDs
16.10.3 Systemic Analgesia Adjuncts
16.11 Postoperative Care
References
17: Anesthetic Concerns in Endocrine Cancers
17.1 Introduction
17.2 Craniopharyngioma
17.2.1 Anesthetic Management
17.2.2 Postoperative Management
17.3 Adrenocortical Tumors
17.3.1 Preoperative Optimization
17.3.2 Induction and Maintenance of Anesthesia
17.3.3 Monitoring and Ventilator Management
17.3.4 Surgical Approach
17.3.5 Analgesia
17.4 Malignant Adrenal Medullary Tumors: Malignant Pheochromocytomas
17.4.1 Presentation
17.4.2 Investigations
17.4.3 Preoperative Optimization
17.4.4 Induction and Maintenance of Anesthesia
17.4.5 Intraoperative Hypertension
17.4.6 Management of Hypertensive Crisis
17.4.7 Postoperative Concerns
17.5 Malignant Carcinoid and Carcinoid Syndrome
17.5.1 Clinical Features
17.5.2 Investigations
17.5.3 Preoperative Assessment
17.5.4 Preoperative Optimization
17.5.5 Anesthetic Management and Treatment of Intraoperative Carcinoid Crisis
17.6 Insulinomas
17.6.1 Anesthetic Concerns
17.7 Parathyroid Tumors
17.7.1 Anesthetic Management of Parathyroidectomy
17.8 Summary
References
18: Anesthesia for Gynecological and Urological Cancer Surgery
18.1 Introduction
18.2 General Overview of Peri-anesthetic Management in Urogynecological Cancer Onco-surgery
18.3 Urological Cancers
18.3.1 Anesthesia for Radical Prostatectomy
18.3.2 Anesthesia for Radical Cystectomy
18.3.3 Anesthesia for Radical Nephrectomy
18.3.4 Anesthesia for Carcinoma Urethra
18.3.5 Anesthesia for Testicular Cancer Surgery
18.3.6 Anesthesia for Cancer of the Penis/Vulva
18.4 Gynecological Cancers
18.4.1 Anesthesia for Surgery of Carcinoma of the Cervix
18.4.2 Anesthesia for Endometrial Cancer
18.4.3 Anesthesia for Ovarian Cancer
18.5 Future Prospects
18.6 Summary
References
19: Anesthesia for Mediastinal Tumors
19.1 Introduction
19.2 Overview of Concerns for Mediastinal Tumors
19.3 Evaluation of the Patient
19.4 Investigations
19.5 Anesthesia Management
19.6 Anesthetic Concerns for Thoracic Robotic Surgery
19.7 Anesthetic Concerns in Pediatric Patients with a Mediastinal Mass
References
20: Anesthesia for Robotic Gynecologic and Urogenital Cancer Surgery
20.1 Introduction
20.1.1 Advancement in Robotic Surgery for Urology
20.1.2 General Anesthetic Considerations for Robotic Urologic and Gynecologic Onco-surgery
20.1.3 Effects of Steep Trendelenburg Position
20.1.4 Effects of Pneumoperitoneum
20.1.5 Effects of Prolonged Surgical Times and Positioning
20.1.6 Monitoring
20.1.7 Fluid Balance
20.1.8 Pain Management
20.1.9 Anesthesia for Robotic Radical Prostatectomy
20.1.10 Anesthesia for Robotic Radical or Simple Nephrectomy
20.1.11 Anesthesia for Robotic Radical Cystectomy
20.1.12 Anesthesia for Robotic Adrenalectomy
20.1.13 Anesthesia for Robotic RPLND (Retroperitoneal Lymph Node Dissection)
20.2 Anesthesia for Robotic-Assisted Gynecologic Surgery
20.2.1 Complications
20.3 Future Prospects
20.4 Summary
References
21: Anesthesia for Cardiac Tumors
21.1 Introduction
21.2 Epidemiology and Morphology
21.3 Tumor Classification Based on Location
21.4 General Clinical Features
21.5 Diagnosis
21.6 Surgical Management
21.7 Anesthetic Management
21.8 Cardiac Transplantation and Artificial Heart
References
22: Anesthesia for Brain Tumors
22.1 Introduction
22.1.1 Tumor Characteristics
22.1.2 Cerebral Autoregulation
22.1.3 Effect of Anesthetic Agents on Cerebral Blood Flow (CBF), Metabolism, and Autoregulation [6]
22.2 Preoperative Evaluation
22.2.1 History and Medical Examination
22.3 Planning for the Anesthesia
22.4 Positions During Neurosurgery
22.5 Anesthetic Management
22.6 Emergence from Anesthesia
22.7 Postoperative Care
22.8 Specific Scenarios
22.8.1 Posterior Fossa Tumor
22.9 Pituitary Adenoma
22.10 Awake Craniotomy
22.11 Ommaya Reservoir Placement
22.12 Tumor Resection Under Intraoperative MRI (iMRI) Guidance
22.13 Use of Tumor Dyes
22.14 Summary
References
23: Anesthesia for Spine Tumors
23.1 Introduction
23.1.1 Tumor Characteristics
23.1.2 Spinal Cord Blood Flow
23.2 Preoperative Evaluation
23.3 Plan for the Spine Surgical Procedure
23.4 Surgical Positioning
23.5 Anesthetic Management
23.5.1 Induction of Anesthesia
23.5.2 Maintenance of Anesthesia
23.5.3 Emergence from Anesthesia
23.6 Postoperative Care
23.7 Summary
References
24: Anesthesia for Pediatric Cancers
24.1 Introduction
24.2 Role of the Anesthesiologist
24.3 Preprocedural Evaluation
24.4 The Psychological Impact of the Disease
24.5 General Considerations in the Cancer Patient
24.5.1 Infection Control Measures
24.5.2 Tumor Lysis Syndrome
24.5.3 Management of Cancer Pain
24.6 Hematological Malignancies
24.7 Anesthesia for Short Procedures
24.7.1 Lumbar Puncture/Bone Marrow Biopsy
24.7.2 Long-Term Venous Access
24.7.3 Radiotherapy
24.7.4 Imaging: Magnetic Resonance Imaging (MRI), Ultrasonography (USG), and Computerized tomography (CT)
24.8 Anesthesia for Major Surgery
24.8.1 Abdominal Tumors
24.8.1.1 Nephroblastoma
Clinical Presentation
Anesthesia Challenges
Preoperative Evaluation
Perioperative Management
24.8.1.2 Hepatoblastoma
Clinical Presentation
Preoperative Evaluation
Anesthesia Challenges
Perioperative Management
24.8.1.3 Pheochromocytoma
Clinical Presentation
Diagnosis and Treatment
Anesthesia Challenges
Perioperative Management
24.8.2 Thoracic Tumors
24.8.2.1 Preoperative Evaluation
24.8.2.2 Anesthesia Challenges
24.8.2.3 Perioperative Management
24.8.3 Medulloblastoma
24.8.3.1 Anesthetic Challenges
24.8.3.2 Perioperative Management
24.8.3.3 Positioning
24.8.4 Sacrococcygeal Teratoma
24.8.4.1 Anesthesia Challenges
24.9 Anticancer Therapy and Its Anesthetic Implications
24.9.1 Oral Cavity and the Airway
24.9.2 Cardiac Toxicity
24.9.3 Pulmonary Toxicity
24.9.4 Renal Toxicity
24.9.5 Hepatic Function
24.9.6 Gastrointestinal Effects
24.9.7 Nervous System
24.9.8 Neuroendocrine System
24.9.9 Hematologic System
24.10 Summary
References
25: Anaesthesia for Video- and Robot-Assisted Onco-surgery
25.1 Introduction
25.2 Minimal Access Surgery Techniques and the Surgical Stress Response
25.3 Physiological Considerations for Laparoscopic Surgery
25.4 Preoperative Assessment and Suitability for the Laparoscopic Approach
25.5 Anaesthetic Strategies for Laparoscopic Cancer Surgery
25.6 Additional Considerations for Robotic Surgery
References
26: Anesthesia for Palliative Surgery
26.1 Introduction
26.2 Preoperative Evaluation
26.3 Specific Palliative Surgical Interventions
26.4 Conclusion
References
Part IV: Analgesia for Onco-Surgery
27: Perioperative Pain Management for Onco-surgery
27.1 Introduction
27.2 Preoperative Education
27.3 Preemptive Analgesia
27.4 Multimodal Analgesia
27.5 Regional Analgesia Techniques
27.6 Pharmacotherapy
27.7 Opioid-Sparing Strategies
27.8 Newer Drugs
27.9 Pain Management in Special Population
27.10 Opioid-Dependent Patient
27.11 The Multidisciplinary Role for Perioperative Pain Management
27.12 Summary
References
Part V: Anaesthesia for Outside the Operating Room Procedures
28: Anesthesia for Radiation Therapy Procedures
28.1 Introduction
28.2 Basic Principles
28.3 Anesthetic Challenges
28.4 Choice of Anesthesia or Sedation
28.5 Concerns During Simulation and Planning for RT
28.5.1 Pre-procedural Concerns
28.5.2 Intra-procedural Concerns
28.6 Intraoperative Radiotherapy (IORT)
28.7 Techniques of IORT
28.8 Unique Anesthetic Considerations of IORT (Fig. 28.4)
28.9 Intraoperative Monitoring
28.10 Anesthesia for Brachytherapy
28.11 Clinical Suitability for Brachytherapy
28.12 Role of Anaesthesiologist During Brachytherapy
28.13 Specific Anesthetic Concerns for Patients Undergoing Brachytherapy
28.14 Pre-anesthetic Evaluation
28.15 Monitoring
28.16 Anesthetic Techniques
28.17 Anesthesia for Cervical Brachytherapy
28.18 Anesthesia for Prostate Brachytherapy
28.19 Head and Neck Brachytherapy
28.20 Anesthesia for Accelerated Partial Breast Irradiation (APBI)
28.21 Post-procedural Care
28.22 Summary
References
29: Anaesthesia and Sedation for Radiological Imaging
29.1 Introduction
29.2 General Considerations
29.2.1 Computed Tomography (CT)
29.2.2 Magnetic Resonance Imaging (MRI)
29.2.2.1 Anesthetic Concerns Specific to MRI Suite
29.3 Anesthetic Management of Cancer Patients for CT/ MRI
29.3.1 Preoperative Assessment and Investigations
29.3.2 Staffing Requirements
29.3.3 Safety Requirements for Imaging Facilities with the Provision of Off-Site Anesthesia
29.3.4 Goals of Anesthesia
29.3.5 Indications of Anesthesia/Sedation
29.3.6 Monitoring
29.3.7 Monitoring and Equipment Concern Specific to MRI
29.3.8 Anesthetic Management of the Patient During CT/MRI
29.3.9 Equipment Check
29.3.10 Airway Management Concerns for CT/MRI Anesthesia
29.3.11 Anesthesia Techniques and Drugs
29.3.12 Medications for Sedation and General Anesthesia
29.3.12.1 Newer Anesthetic/ Sedative Agents
29.3.13 Target-Controlled Infusion (TCI)
29.3.14 Patient-Controlled Sedation
29.3.15 General Anesthesia (GA)
29.3.16 Management of Emergencies in Radiation Suite
29.3.16.1 Management of Cardiopulmonary Collapse/ Arrest in MRI Suite
29.3.16.2 Adverse Reactions to Iodinated Contrast Media
29.3.16.3 Fire Emergency
29.3.16.4 Projectile Emergencies
29.3.16.5 Unintentional Quench
29.3.17 Recovery Care
29.4 Summary
References
30: Anesthesia for Endoscopic Gastrointestinal Procedures
30.1 Introduction
30.2 Gastrointestinal Procedures an Overview
30.3 Pre-procedure Patient Valuation and Risk Stratification
30.4 Drugs Used for Sedation in Gastroenterology Suite
30.5 Drugs for the Future
30.6 Airway Devices Unique to Endoscopy
30.6.1 Patient Monitoring
30.6.2 Positioning the Patient
30.7 Sedation for Gastroenterology: Time for a Specialized Field
30.8 Summary
References
31: Anesthesia for Onco-Radiosurgery
31.1 Introduction
31.2 Stereotactic Radiosurgery Procedures
31.2.1 Perioperative Considerations
31.2.2 Choice of Anesthesia
31.2.3 Local Anesthesia
31.2.4 General Anesthesia
31.2.5 Anesthetic Management and Technical Challenges
31.3 Summary
References
Part VI: Onco-Critical Care
32: Onco-Critical Care
32.1 Introduction
32.2 Patient Admission into Oncology Critical Care
32.2.1 Trends in Onco-Critical Care
32.2.2 Challenges in Onco-Critical Care
32.3 Critical Care Issues in Oncology
32.3.1 Tumor Lysis Syndrome (TLS)
32.3.2 Hypercalcemia
32.3.3 Hyponatremia
32.3.4 Acute Respiratory Failure
32.3.5 Management of Acute respiratory distress syndrome (ARDS) in ICU
32.3.5.1 Role of Noninvasive Ventilation (NIV) in ARDS Management
32.3.5.2 Role of High-Flow Oxygen Therapy in ARDS Management
32.3.6 Sepsis
32.3.7 Airway Emergencies
32.3.8 Acute Abdomen
32.3.9 Cardiac Failure and Cardiac Tamponade
32.3.10 Central Nervous System (CNS) Emergencies
32.3.11 Adrenal Crisis or Adrenal Insufficiency
32.4 Postoperative Care in Oncology
32.5 Transfusion Practices in Onco-Critical Care
32.6 Chemotherapy in ICU
32.7 Infection Control in ICU
32.8 Nutrition in Onco-Critical Care
32.9 ICU Outcomes of Cancer Patients
32.10 Palliative Care in ICU
32.11 End-of-Life Care (EOLC) in ICU
32.12 Integrated Intensive Care Management of Onco-Critical Care
32.13 Summary
References
Part VII: Allied Onco-Specialties
33: Palliative and End-of-Life Care for Advanced Cancer
33.1 Introduction
33.2 Palliative Care in Advanced Cancer
33.3 Palliative Care and ICU
33.4 Palliative Onco-Surgery
33.5 End-of-Life Care (EOLC)
33.6 Initiatives to Enhance EOLC
33.7 Summary
References
Part VIII: Miscellaneous
34: Perioperative Complications in Oncosurgeries
34.1 Introduction
34.2 Perioperative Complications in Oncosurgeries
34.3 General Perioperative Complications in Oncosurgeries
34.3.1 Inadvertent Perioperative Hypothermia (IPH)
34.3.2 Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)
34.3.3 Perioperative Injuries
34.3.4 Postoperative Pulmonary Complications (PPC)
34.3.5 Perioperative Sepsis
34.3.6 Postoperative Nausea and Vomiting
34.3.7 Postoperative Atrial Fibrillation (POAF)
34.3.8 Chronic Postsurgical Pain (CPSP)
34.4 Specific Perioperative Complications in Oncosurgeries
34.4.1 Chemotherapy- and Radiotherapy-Related Perioperative Complications
34.4.2 Challenges of Chronic Opioid Therapy
34.4.3 Malnutrition, Hypoalbuminemia, and Anemia
34.4.4 Difficult Airway
34.4.5 Problems of Brachytherapy and Intraoperative Radiation
34.4.6 Carotid Blow Out Syndrome
34.4.7 Microvascular Flap Necrosis
34.4.8 Chyle Leak and Its Management
34.5 Summary
References
35: Anesthesia for Operative Oncological Emergencies
35.1 Introduction
35.2 General Considerations
35.3 Malignant Bowel Obstruction
35.3.1 Preoperative Optimization
35.3.2 Anesthetic Management
35.3.3 Postoperative Period
35.4 Bowel Perforation
35.5 Malignant Spinal Cord Compression
35.5.1 Preoperative Evaluation
35.5.2 Intraoperative Management
35.5.3 Postoperative Management
35.6 Surgery for Brain Metastases
35.7 Tumor Bleeding
35.8 Summary
References
36: Enhanced Surgical Recovery and Cancer
36.1 Introduction
36.2 Preoperative Preparation
36.2.1 Advanced Care Planning
36.2.2 Education
36.2.3 Nutritional Concerns
36.2.3.1 Prehabilitation
36.3 Intraoperative Management
36.3.1 Postoperative Nausea and Vomiting (PONV) Prophylaxis
36.3.2 Fluid Management
36.3.3 Multimodal Pain Management
36.4 Postoperative Care
36.4.1 Pain Management Maintenance
36.4.2 Postsurgical Complications and Return to Intended Oncological Therapies (RIOT)
36.4.3 Health-Related Quality-of-Life Assessment
36.5 Summary
References
37: Anesthesia for Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
37.1 Introduction
37.2 Patient Selection/Indications
37.2.1 Methods of HIPEC
37.2.2 Mechanism of Action of HIPEC
37.2.3 Concerns for CRS and HIPEC
37.2.3.1 Cardiovascular Changes
37.2.3.2 Respiratory Changes
37.2.3.3 Renal Changes
37.2.3.4 Coagulation Alterations
37.2.3.5 Metabolic Perturbations
37.2.3.6 Nutrition
37.2.4 Preoperative Assessment
37.2.4.1 Cardiovascular System
37.2.4.2 Respiratory System
37.2.4.3 Renal
37.2.4.4 Coagulation Status
37.2.4.5 Nutrition Status
37.2.5 Preoperative Optimization
37.2.5.1 Cardiovascular System
37.2.5.2 Respiratory System
37.2.5.3 Renal System
37.2.5.4 Nutrition
37.2.5.5 Prehabilitation
37.3 Temperature Regulation
37.3.1 Perioperative Pain Management
37.4 Drugs for HIPEC
37.4.1 HIPEC: Carrier Solution
37.4.2 Intraoperative Period
37.4.2.1 Intraoperative Monitoring
37.4.2.2 Airway and Ventilatory Management
37.4.2.3 Hemodynamic Management
37.4.2.4 Fluid and Blood Management
37.4.2.5 Renal System and Electrolyte Balance Management
37.4.2.6 Antiemetics
37.4.3 Postoperative Management
37.4.3.1 Anesthesiologists and Operating Room Safety Issues with HIPEC
37.5 Predictors/Markers of Perioperative Morbidity and Mortality
37.6 Other Hyperthermic Chemotherapy Surgical Procedures
37.6.1 Pressurized Intraperitoneal Aerosolized Chemotherapy (PIPAC)
37.6.2 Hyperthermic Intrathoracic Chemotherapy
37.7 Summary
References
38: Perioperative Anemia Management for  the Onco-Surgical Patient
38.1 Introduction
38.2 Erythropoiesis-Stimulating Agents and Iron
38.3 Blood Transfusions
38.4 Transfusion-Related Immunomodulation
38.5 Blood Transfusions and Its Impact on Prostate Cancer
38.6 Blood Products: Leukoreduction
38.7 Blood Products: Cytomegalovirus (CMV) Negative
38.8 Blood Products: Irradiated Blood Components
38.9 Intraoperative Blood Salvage
38.10 Preoperative Blood Conservation Strategies: Acute Normovolemic Hemodilution and Preoperative Autologous Blood Donation
38.11 Summary
References