[Anesthesia for the patient with cancer]

Area of Science:

• Oncology
• Anesthesiology
• Internal Medicine

Context:

• Cancer patients present unique physiological challenges impacting anesthesia.
• Tumors can directly affect vital systems like respiratory, cardiovascular, and neurological functions.
• Systemic complications such as coagulopathy, anemia, and metabolic disturbances are common.

Purpose:

• To highlight the anesthetic implications of cancer and its treatments.
• To emphasize the importance of comprehensive preoperative evaluation.
• To outline key considerations for intraoperative and postoperative management.

Summary:

• Anesthetic management must account for tumor involvement (airways, intracranial pressure) and systemic effects (hemostasis, immunity, metabolism).
• Radiotherapy and chemotherapy introduce specific challenges: radiotherapy affects treated areas, while chemotherapy causes systemic toxicity (mucositis, aplasia, cardiotoxicity, pulmonary toxicity).
• Preoperative assessment should evaluate tumor burden and treatment sequelae. Surgical preparation may involve nutritional support and central venous access. Intraoperative care necessitates tailored monitoring and access, with prophylactic antiemetics and antithrombotics.
• Postoperative care focuses on pain control, early nutrition, infection prevention, and prophylaxis against thrombosis and nausea, alongside pressure ulcer prevention.

Impact:

• Informed anesthetic planning improves patient safety and surgical outcomes in oncology.
• Understanding treatment-specific toxicities allows for proactive management of perioperative risks.
• Optimized perioperative care can mitigate complications and enhance recovery for cancer patients undergoing surgery.