Preoperative Preparation in breast cancer

سال انتشار: 1394
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 331

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شناسه ملی سند علمی:

ICBCMED12_029

تاریخ نمایه سازی: 2 تیر 1397

چکیده مقاله:

Patients may be healthy or desperately ill with nutritional, neurologic, metabolic, endocrinologic, electrolyte, cardiac, pulmonary, renal, hepatic, hematologic, pharmacologic disabilities. Therefore, requires evaluation of all systems. Abnormalities include: hypercalcemia, uric acid nephropathy, hyponatremia,nausea, vomiting, anorexia, cachexia, fever, hypoglycemia, intracranial metastases, peripheral nerve or spinal cord disorders, meningeal carcinomatosis, toxic neuropathies secondary to anticancer therapy,paraneoplastic neurologic syndromes. Correction of nutrient deficiencies, anemia, coagulopathy, electrolyte abnormalities needed preoperatively. Nausea and vomiting are the most common side effects of chemotherapy and radiation treatment. Ondansetron, droperidol, metoclopramide control nausea. Tricyclic antidepressants are useful forpotentiating analgesic effects of opioids and producing some inherent analgesia. Opioids used to manage cancer pain may be responsible for preoperative sedation. Presence of hepatic or renal dysfunction may influence the choice of anesthetic drugs. Prolonged response to succinylcholine is a consideration in alkylating chemotherapeutic drugs(cyclophosphamide).Attention to aseptic technique is important because immunosuppression occurs with most chemotherapeutic agents. Immunosuppression produced by anesthesia, surgical, blood transfusion. Patients may have life-threatening airway difficulties and upper airway obstruction with head, neck, chest tumors. Preoperative preparation is required to assess potential difficulties that may arise in securing the airway. Awake fiberoptic intubation is the gold standard for difficult airway management. In some patients, tracheostomy may be indicated. Preoperative evaluation includes a review of potential side effects related to chemotherapy. Placement ofi.v catheters in the arm at risk of lymphedema is avoided because exacerbation of lymphedema and susceptibility to infection. It is necessary to protect arm from compression and heat exposure. Presence of bone pain and pathologic fractures is noted in regional anesthesia and positioning. Selection of anesthetic drugs, techniques, special monitoring is influenced more by planned surgical procedure than by presence of breast cancer. Isosulfan blue dye during surgery cause transient decrease in SpO2 value.

نویسندگان

Hamid Zahedi

Associate Professor of Anesthesiology