Anesthetic Implications of Anticancer Chemotherapeutic Agents

Abstract

The majority of patients receiving anticancer chemotherapy will require anesthesia either for primary debulking, removal of tumor, treat an adverse consequence of malignant processor its treatment, or for other surgeries not related to the tumor. To manage these patients effectively, it is important to be familiar with the pharmacology of various chemotherapeutic agents and to understand the physiological changes that may occur during the course of treatment and its anesthetic implications. Preoperative assessment should include a detailed drug history including the chemotherapy regimen used and any specific toxic effects on the various body system organs. The anesthetic technique should be modified according to the systemic changes produced by chemotherapeutic agents. Adequate vascular access is very important in oncologic patients. It is important in the initial phase of surgical treatment or chemotherapy, as well as in chronic management of advanced cancer and in the palliative care setting.

Intraoperative anesthetic management of patients receiving anticancer chemotherapeutic agents is a challenge for the anesthesiologists who must be familiar with the implications of cancer, chemotherapy and the surgery itself for the anesthetic technique. Potentially toxic anesthetic drugs, e.g., local anesthetics, inhaled anesthetics and nitrous oxide, should be used carefully. Analgesia should be provided with special attention to drug interactions and increased opioid requirement in opioid-dependent patients, achieving a balance between good pain control and minimal side effects. Postoperatively, the anesthesiologist will be faced with both cancer and organ failure as risk factors that may need care for the patient at a critical care unit (CCU).