الفهرس 
PATHOPHYSIOLOGY COMMON TOOnly 14 pages are availabe for public view
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Abstract
A majority of cancer patient will require anesthesia either for primary debulking or removal of tumour or to treat an adverse consequence of maligent process or its treatment. Therefore we outline here the pathophysiology of cancer, effect of tumour and effect chemotherapy and radiotherapy on major organ systems. It is becoming increasingly common for patients who are receiving chemotherapy to present for anaesthesia or for potential admission to the intensive care unit.
To effectively manage these patients care, it is important to be aware of both the short- and long-term side effects of chemotherapeutic agents, and to understand the physiological changes that may occur during the course of their treatment. Complications such as nausea and vomiting and diarrhoea are well recognised and may cause metabolic disturbances that are relevant to anaesthesia and critical care. However, many treatments have side effects which are more organ specific and severity may not necessarily be dose related. These include cardiomyopathies and irreversible lung fibrosis.
Adequate vascular access is of paramount importance in oncology patients. It is important in the initial phase of surgical treatment or chemotherapy, as well as in the chronic management of advanced cancer and in the palliative care setting. We present an overview of the available vascular access devices and of the most relevant issues regarding insertion and management of vascular access
Major head and neck cancer surgery presents many specific anaesthetic challenges, with the increased likelihood of a difficult airway and the challenges of the shared airway. It is imperative to have a preplanned strategy for managing the airway and this requires close liaison and communication between the surgical and anaesthetic teams both for intubation and for extubation. Awake fibreoptic intubation is not a panacea for all ills, especially in cases of tight laryngeal stenosis, acute stridor, or a friable tumor prone to bleeding when cricothyroidotomy or tracheostomy under local anaesthesia should also be considered (in conjunction with the ENT surgeons). Intraoperatively, there are other issues to consider and in particular the anaesthetist should maintain a high index of suspicion for venous air embolism and concealed blood loss. The post-operative airway strategy is just as important as intubation and should be planned in advance. Prolonged surgery, swelling and possible post-operative bleeding can all result in airway compromise and intra-operative tracheostomy insertion may be the safest option
Mediastinal mass syndrome remains an anaesthetic challenge that cannot be underestimated. Depending on the localization and the size of the mediastinal tumour, the clinical presentation is variable ranging from a complete lack of symptoms to severe cardiorespiratory problems. The administration of general anaesthesia can be associated with acute intraoperative or postoperative cardiorespiratory decompensation that may result in death due to tumour-related compression syndromes. The role of the anaesthesiologist, as a part of the interdisciplinary treatment team, is to ensure a safe perioperative period. Proper anaesthetic management of patients with mediastinal mass syndrome begins with an assessment of the preoperative status, directed foremost at establishing the localization of the tumour and on the basis of the clinical and radiological findings, discerning whether any vital mediastinal structures are affected. During the preoperative period, we are guided by points plan that also takes into account the special features of transportation into the operating theatre and patient monitoring. Tumour compression on the airways or the great vessels may create a critical respiratory and/or haemodynamic situation, and therefore the standard of intraoperative management includes induction of anaesthesia in the operating theatre on an adjustable surgical table, the use of short-acting anaesthetics, avoidance of muscle relaxants and maintenance of spontaneous respiration.
Surgical resection of abdominal malignancy remains the mainstay of cancer management. Anaesthetists should have a sound understanding of liver pathophysiology, coagulation disturbances and blood transfusion management to optimise the perioperative care of this patient group. Anaesthesia management of liver resection surgery includes careful patient selection with comprehensive preoperative assessment, understanding complex surgical techniques, perioperative fluid management, choice of anaesthesia, the perioperative analgesia and postoperative complications
Surgical resection of urological malignancy is increasingly performed due to advances in minimal access surgery and the capability to operate on patients with greater comorbidities. An overview of each of the specific procedures involved is provided, detailing operative parameters such as monitoring and patient positioning as well as common complications. Analgesia and fluid management in the post-operative period
Haematopoietic stem cell transplantation (HSCT) is becoming an increasingly common therapy for the treatment of a wide variety of haematological cancers. Patients undergoing this procedure are commonly unwell even before its inception, and the pretreatment conditioning regimes often worsen their physiological state and expose them to multiple infective risksy. As such they often present tothe Intensivist for assessment and management,
Children with cancer present unique challenges to all concerned with their management. The disease process and its treatment can have a profound impact on the patient’s physiological and psychological state. Anaesthetists are often involved in the diagnosis, treatment and emergency resuscitation of these patients and the increasing role played by the anaesthetist as part of the multidisciplinary team caring for these children.
The pre-eminent view amongst intensivists when presented with an acutely ill patient with cancer needing admission to the ICU has long been ‘‘However, more recent work has shown that it is progression of disease and its contribution to acute physiological derangement that matters, not the diagnosis alone. Once admitted, again it is the severity of acute disturbance and progression of organ failure that influences the outcome