Problem Based Learning Discussions in Onco-Anesthesia and Onco-Critical Care

Foreword
Contents
About the Editors
1: Carcinoma Buccal Mucosa with Trismus Posted for Hemimandibulectomy and Free Flap Reconstruction
	1.1	 Introduction
	1.2	 Preoperative Assessment
		1.2.1	 Implications of RT CT
	1.3	 Preoperative Investigations
	1.4	 Preoperative Nutritional Optimisation
	1.5	 Intraoperative Management
		1.5.1	 The Shared Airway
	1.6	 Trismus
		1.6.1	 Airway Management in Trismus
	1.7	 Intraoperative Monitoring
	1.8	 Position of the Patient
	1.9	 Perioperative Management Including ERAS
	1.10	 Anaesthetic Considerations in Free Flap
		1.10.1	 Postoperative Flap Monitoring
	1.11	 Venous Thromboembolism Prophylaxis
	1.12	 Tracheostomy
	1.13	 Extubation
	1.14	 Criteria for ICU Admission in the Postoperative Perio
	1.15	 Analgesia Management
	References
2: Anaesthesia and Perioperative Concerns in Total Laryngectomy
	2.1	 Case Vignette
		2.1.1	 Define Total Laryngectomy? Contrast It with Other Partial Surgical Modalities
		2.1.2	 What Are the Quality of Life Affecting Concerns in a Patient Planned for ‘Total Laryngectomy’?
		2.1.3	 What Is the Incidence of Laryngeal Cancer in India and Worldwide? What Are the Main Risk Factors Associated with This Malignancy?
		2.1.4	 Describe the TNM Staging for Ca Larynx
		2.1.5	 How Do You Evaluate and Prehabilitate These Patients?
		2.1.6	 What Are the Toxicities Associated with Chemotherapeutic Agents Used in Ca Larynx?
		2.1.7	 What Can Be the Airway-Related Concerns in a Patient of Ca Larynx Posted for Total Laryngectomy? [5–7]
		2.1.8	 Specific Intraoperative Concerns?
		2.1.9	 Role of Enhanced Recovery After Surgery (ERAS) Protocols in Laryngectomy Cases?
		2.1.10	 Main Postoperative Concerns After Total Laryngectomy?
		2.1.11	 What Are the Available Options for Postoperative Voice Rehabilitation After Laryngectomy and a Permanent Tracheostome? List Out Complications of Such Voice Prosthetic Devices
	2.2	 Complications of Speech Valves
		2.2.1	 How Do You Manage a Post-laryngectomy Patient Posted for Other Surgical Procedures?
		2.2.2	 What Are the Complications of Laryngectomy?
	References
3: Carcinoma Trachea for Tracheal Resection and Anastomosis
	3.1	 Case
	3.2	 Preoperative Evaluation
		3.2.1	 Clinical Evaluation
	3.3	 Investigations
	3.4	 Surgical Considerations
	3.5	 Intraoperative
	3.6	 Extubation
	3.7	 Postoperative
	References
4: Anterior Mediastinal Mass for Mediastinoscopy and Proceed
	4.1	 Case Scenario
	4.2	 Introduction
	4.3	 Describe Anatomy of Mediastinum?
	4.4	 What is Differential Diagnosis of a Mediastinal Mass?
	4.5	 How do Patients with Mediastinal Mass Present Clinically?
	4.6	 Enumerate the Signs and Symptoms of Mediastanal Compression?
		4.6.1	 Tarcheobrpnchial Compresison
		4.6.2	 Vascular Compression
	4.7	 Enumerate Major Anesthetic Concernds in this Patient?
		4.7.1	 Preoperative Evaluation and Investigations
		4.7.2	 Discuss Anesthetic Management in this Patient
			4.7.2.1	 Induction and Intubation
			4.7.2.2	 Ventilation
	4.8	 Enumerate Special Consoderations for Mediastinoscopy
	4.9	 Enumerate Complictaions in the Postoperative Period
		4.9.1	 Respiratory Collapse
		4.9.2	 Cardiovascular Collapse
		4.9.3	 Emergence and Recovery
		4.9.4	 Postoperative Care
	References
5: Anesthetic Considerations for a Patient with Carcinoma Lung Scheduled for Lobectomy or Pneumonectomy
	5.1	 Case Scenario
	5.2	 Enumerate the Risk Factors, Major Types of Lung Malignancies, and Their Common Manifestations Along with Their Prognosis?
	5.3	 Enumerate the Advantages and Disadvantages of Different Surgical Options Available
	5.4	 What Different Evaluations Are Required for this Patient Apart from Routine Assessment?
	5.5	 Determining the Actual Contribution of the Segments to Current Overall Functioning of the Lungs
	5.6	 Other Risk Factors
	5.7	 What Aspects of Airway Evaluation Are Relevant to Management of These Patients?
	5.8	 What Are the Various Optimization Options Available for this Patient?
	5.9	 Why Is One Lung Ventilation (Lung Isolation) Required? Briefly Describe the Various Available Lung Isolation Techniques. Present the Intricacies of Choosing an Appropriate Lung Isolation Device for a Given Patient
	5.10	 Discuss the Anatomy of the Tracheobronchial Tree Relevant to One Lung Ventilation with Specific Emphasis on the Margin of Safety
	5.11	 Discuss the Relevance of Hypoxic Pulmonary Vasoconstriction (HPV) in These Patients. Detail the Influence of Anesthetic Agents on the HPV Response
	5.12	 What Preoperative Investigations and Premedication Are Required for this Patient?
	5.13	 Outline the Overall Flow of the Patient Scheduled for Thoracic Surgery
	5.14	 Discuss the Various Intraoperative Monitoring Options and Preparations Required During the Management of this Patient?
	5.15	 Describe the Technique of Left-Sided Double Lumen Tube Insertion and the Methods to Confirm Its Ideal Location
	5.16	 Confirmation of Ideal Positioning of the DLT
	5.17	 Describe the Technique of Insertion and Confirmation of Ideal Location of Bronchial Blockers
	5.18	 Discuss the Anesthetic Drug Choices for Induction and Maintenance of Anesthesia
	5.19	 Enumerate the Main Precautions to be Taken While Positioning the Patient in Lateral Decubitus Position
	5.20	 Discuss the Alterations in Ventilation and Perfusion Related to Lateral Decubitus Position, When Thorax Is Intact and When Open, with Patient Spontaneously Breathing and Paralyzed
	5.21	 Enumerate the Various Options for Intraoperative and Postoperative Analgesia
	5.22	 Discuss the Ventilatory Strategy for the Management of OLV
	5.23	 Detail Your Plan for Intraoperative Hypoxemia Management
	5.24	 Discuss the Essential Principles in Fluid Management in These Patients
	5.25	 Enumerate the High-Risk Factors for the Development of Post-procedure Acute Lung Injury
	5.26	 Outline the Salient Points for On Table Extubation of Patients Following Various Types of Lung Resection Surgery
		5.26.1	 Enumerate the Essential Principles for Postoperative Care of These Patients
		5.26.2	 Briefly Discuss the Immediate Life-Threatening Postoperative Problems and Discuss the Troubleshooting for the Same
		5.26.3	 Briefly Discuss the Differences Between Open Thoracotomy, VATS, and NIVATS with Respect to Anesthetic Techniques and Concerns
		5.26.4	 Discuss the Principles of Enhanced Recovery After Thoracic Surgery
	5.27	 What Are the Specific Considerations for the Patient with Post-pneumonectomy Status If Scheduled to Undergo (a) Another Lung Resection Surgery in the Future (b) to Undergo Incidental Surgery in the Future
	References
6: Malignant Melanoma Foot for Isolated Limb Perfusion
	6.1	 Case
	6.2	 What Is Malignant Melanoma (MM) and What Is the Incidence of the Disease?
	6.3	 What Are the Risk Factors for Malignant Melanoma?
	6.4	 How Is the Diagnosis of Malignant Melanoma Done?
	6.5	 What Is the TNM Staging of Malignant Melanoma?
	6.6	 What Are the Treatment Strategies Available for Malignant Melanoma?
	6.7	 What Are the Indications for HILP for Treatment of MM?
	6.8	 Briefly Describe the HILP in Brief
	6.9	 How Is HILP Different from Cardiopulmonary Bypass and What Precautions Are to Be Taken?
	6.10	 What Are the Special Anesthesia Preparations Required During the Preoperative Period?
	6.11	 Describe the Intraoperative Anesthesia Management
	6.12	 Describe the Operative and Perfusion Technique
	6.13	 What Are the Intraoperative Blood Testing Strategies?
	6.14	 What Is the Dose of Melphalan to Be Given Intraarterially During the Procedure?
	6.15	 What Are the Possible Side Effects Because of Usage of Melphalan?
	6.16	 Should Regional Anesthesia in the Form of Central Neuraxial Block Be Used During the Intraoperative Phase?
	6.17	 Why Core Body Temperature Monitoring Is Essential During the Surgery?
	6.18	 What Is the Importance of Close Monitoring of Limb Venous Pressure?
	6.19	 Which Are the Different Leak Assessment Techniques and What Are the Qualities of a Good Leak Assessment Test?
	6.20	 Mention the Other Drugs Which Can Be Used Apart from Melphalan?
	6.21	 What Are the Important Considerations in the Postoperative Phase?
	6.22	 Which Groups of Patients Are Considered High Risk and Not Eligible for the Procedure?
	6.23	 What Are the Other Oncological Cases Where the Use of Isolated Hyperthermia Perfusions Is Being Considered Apart from Malignant Melanoma?
	6.24	 What Are the Differences between HILP and ILI (Isolated Limb Infusion)?
	6.25	 What Are the Postoperative Complications of HILP and ILP?
	6.26	 Who all Must Be the Part of Multidisciplinary Team Management in a Case of HILP?
	References
7: Anesthetic Considerations for a Patient with Carcinoma Esophagus Scheduled for Ivor-Lewis Esophagectomy
	7.1	 Case Scenario
	7.2	 Introduction: Overview of Esophageal Carcinoma
		7.2.1	 Classify the Esophageal Neoplasms Based on Their Histological Characteristics
		7.2.2	 Is There Any Difference in the Histological Types of Ca Esophagus Between Developing and Developed Countries? How Does It Differ Between Upper and Lower Esophagus?
		7.2.3	 What Are the Risk Factors for Developing Ca Esophagus?
		7.2.4	 What Are the Common Presenting Symptoms of Carcinoma Esophagus?
		7.2.5	 What Are the Most Common Sites of Metastases in the Ca Esophagus? What Is the Median Survival/5-Year Survival Rate for Carcinoma Esophagus?
		7.2.6	 Describe the Eighth AJCC Staging of Carcinoma Esophagus and Their Clinical Implications?
		7.2.7	 What Are the Staging Investigations for Carcinoma Esophagus?
		7.2.8	 What Are the Treatment Options Available for Carcinoma Esophagus?
	7.3	 Preoperative Evaluation and Management
		7.3.1	 How Do You Evaluate These Patients in the PAC Clinic?
		7.3.2	 What Are the Systemic Toxicities of Preoperative Chemotherapies in a Patient with Carcinoma Esophagus?
		7.3.3	 What Are the Toxicities of Thoracic Radiation in Carcinoma Esophagus?
		7.3.4	 What Is the Ideal Time to Schedule a Patient for Surgery Who Has Received Neoadjuvant Therapies?
		7.3.5	 What Are the Preoperative Investigations Needed for This Patient?
		7.3.6	 What Are the Preoperative Procedure-Specific Risk Stratification Tools for Patients Posted for Esophagectomy?
		7.3.7	 How Will You Optimize the Patient with Carcinoma Esophagus Before Surgery?
		7.3.8	 What Will Be Your Preoperative Fasting Guidelines and Advice for Bowel Preparation for This Patient?
	7.4	 Intraoperative Management
		7.4.1	 Discuss the Premedication, Monitoring, and Anesthesia Plan for These Patients
		7.4.2	 Enumerate the Different Surgical Techniques Available and Discuss the Pros and Cons for Individual Techniques
		7.4.3	 Discuss the Concerns Associated with Surgical Techniques Contributing to Early Recovery in Esophagectomy Patients?
		7.4.4	 What Are the Concerns during Anesthesia Induction and Maintenance in These Surgeries?
		7.4.5	 How Do You Manage the Airway in these Patients and Discuss Their Pros and Cons?
		7.4.6	 Discuss the Intraoperative Ventilatory Strategies in These Patients
		7.4.7	 Outline the Management of Intraoperative Hypoxia During One-Lung Ventilation
		7.4.8	 Discuss the Intraoperative Fluid and Blood Products Management Strategies
		7.4.9	 What Will Be Your Extubation Strategy and Place for Postoperative Care?
	7.5	 Postoperative Management
		7.5.1	 Describe the Pain Management in Esophagectomy Patients
		7.5.2	 How Will You Manage the Drains, Tubes, Catheters, Feeding, and Thromboprophylaxis in the Postoperative Period?
		7.5.3	 What Are the Postoperative Complications That You Can Expect in Esophagectomy Patients?
			7.5.3.1	 Early Complications
			7.5.3.2	 Late Complications
		7.5.4	 How Do You Manage Postoperative Atrial Fibrillation Following Esophagectomy
			7.5.4.1	 Prevention of Arrhythmia
			7.5.4.2	 Treatment of Arrhythmia
		7.5.5	 Enumerate the Principles of ERAS in Esophagectomy
	References
8: Chondrosarcoma Pelvis for Internal Hemipelvectomy
	8.1	 Case Scenario
	8.2	 Pain Relief: Intraoperative
	8.3	 Component Therapy
		8.3.1	 Red Blood Cells
		8.3.2	 Fresh Frozen Plasma (FFP)
	8.4	 Techniques to Reduce Blood Loss
		8.4.1	 Anesthetic Strategies to Reduce Blood Loss
			8.4.1.1	 Permissive Hypotension Central Neuraxial Block
			8.4.1.2	 Patient Positioning
			8.4.1.3	 Avoidance of Hypothermia
			8.4.1.4	 Ventilation Strategies
		8.4.2	 Other Strategies to Reduce Blood Loss
			8.4.2.1	 Role of Antifibrinolytics
			8.4.2.2	 Diathermy
			8.4.2.3	 Topical Agents
	References
9: Periampullary Carcinoma for Whipple’s Procedure
	9.1	 Case
	9.2	 Pathophysiological Changes in the Gastrointestinal Tract
	9.3	 Renal System
	9.4	 Hepatic System
	9.5	 Cardiovascular Effects
	9.6	 Optimization of Pulmonary Function
	9.7	 Correction of Dehydration and Malnutrition
	9.8	 Correcting Coagulation Profile
	9.9	 Anti-Thrombotic Prophylaxis
	9.10	 Premedication
	9.11	 Induction Agents/Intravenous Anaesthetics
	9.12	 Inhalation Anaesthetics
	9.13	 Neuromuscular Blocking Drugs
	9.14	 Analgesics
		9.14.1	 Opioids
		9.14.2	 Acetaminophen
		9.14.3	 Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
	9.15	 Intraoperative Fluid Management
	References
10: Anaesthetic Considerations in Patients with Carcinoma Prostate for Robot-Assisted Laparoscopic Radical Prostatectomy
	10.1	 Case Vignette
	10.2	 What Are the Risk Factors and Clinical Features of Ca Prostate?
	10.3	 Briefly Describe the Da Vinci System
	10.4	 What Are the Goals in Robotic Surgeries? What Are the Measures to Reduce the Complications?
	10.5	 What Is Docking of the Robot?
	10.6	 Describe the Preoperative Assessment Patients Posted for Robotic Prostatectomy
		10.6.1	 Preoperative Assessment
		10.6.2	 Ergonomics
	10.7	 Describe the Intraoperative Management of a Patient Posted for Robotic Prostatectomy
		10.7.1	 Intraoperative Management
		10.7.2	 Airway Management
		10.7.3	 Patient Positioning
		10.7.4	 Pulmonary Considerations
		10.7.5	 Haemodynamic Considerations
		10.7.6	 Monitoring
		10.7.7	 Intraoperative Fluid Therapy
	10.8	 What Are the Postoperative Issues and How Will You Manage Them?
		10.8.1	 Airway Management
		10.8.2	 Pain Management
		10.8.3	 Deep Venous Thrombosis(DVT) Prophylaxis
	10.9	 Describe the Enhanced Recovery After Surgery ERAS Protocols for Robotic Radical Prostatectomy
	10.10	 Summary
	References
11: Carcinoma Urinary Bladder for Cystectomy and Ileal Conduit
	11.1	 What Are Different Available Treatment Options for Carcinoma Urinary Bladder?
	11.2	 What Is Neoadjuvant Chemotherapy? What Are the Side Effects of Cisplatin?
	11.3	 Describe Radical Cystectomy. How Do You Define Ileal Conduit? What Are Alternative Diversion Procedures Available?
	11.4	 Preoperative Evaluation and Optimization
		11.4.1	 How Would You Evaluate the Patient Preoperatively? What Preoperative Work-Up Is Required?
		11.4.2	 What Are the Common Types of Bladder Cancer? Describe the Risk Factors Associated with Bladder Cancer?
			11.4.2.1	 Thromboprophylaxis
			11.4.2.2	 Preoperative Fasting
			11.4.2.3	 Antimicrobial Prophylaxis
			11.4.2.4	 Prevention of PONV
	11.5	 Intraoperative Period
		11.5.1	 Discuss Monitoring and Anesthesia Plan for these Patients. What Are Intraoperative Considerations?
		11.5.2	 How to Prevent Intraoperative Hypothermia in These Extensive Surgeries?
		11.5.3	 How to Monitor Urine Output in Genitourological Surgeries?
		11.5.4	 Enumerate the Different Anesthetic Plans Available and Discuss Their Pros and Cons
		11.5.5	 Discuss the Fluid Management in these Patients
		11.5.6	 Discuss all Available Options for Perioperative Analgesia
	11.6	 Postoperative Period
		11.6.1	 Enumerate the Postoperative Complications that May Arise in Immediate Postoperative Period in these Patients. Discuss the Principles of Enhanced Recovery after Genitourinary Surgery
		11.6.2	 Components of ERAS Protocol in Radical Cystectomy
		11.6.3	 Describe the Risk Factors Associated with Morbidity and Mortality Following Radical Cystectomy
	References
12: Renal Cell Carcinoma for Laparoscopic Nephrectomy
	12.1	 Case
	References
13: Carcinoma Cervix for Pelvic Exenteration
	13.1	 Case
	13.2	 What Is Pelvic Exenteration?
	13.3	 What Are the Indications and Contraindications for PE?
	13.4	 How Will you Evaluate and Prepare for this Patient Prior to Surgery?
	13.5	 What Are the Anaesthetic Considerations for PE?
	13.6	 How Will you Ensure Smooth Coordination of Care?
	13.7	 What Is the Role of Mechanical and Pharmacological Thromboprophylaxis?
	13.8	 What Is the Correct Positioning of the Patient During PE?
	13.9	 What Are Your Strategies for Intraoperative Fluid Management?
	13.10	 How Will you Prevent Intraoperative Hypothermia?
	13.11	 How Do you Anticipate Possible Massive Haemorrhage?
	13.12	 What Are your Strategies for Pain Management?
	13.13	 How Would you Manage Stress Responses and What Are Your Strategies for Postoperative Care?
	13.14	 What Are the Postoperative Complications?
	References
14: Anaesthetic Management of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
	14.1	 Case
	14.2	 HIPEC
		14.2.1	 What Are the Indications/Contraindications for HIPEC?
		14.2.2	 What Are the Criteria for Patient Selection for These Procedures
		14.2.3	 What Are the Disease Scoring Systems Used for Patient Selection/Prognostication in HIPEC?
		14.2.4	 What Is the Rationale Behind HIPEC?
		14.2.5	 What Are the Methods/Techniques for Intraperitoneal Administration of Hyperthermic Chemotherapy?
		14.2.6	 What Are the Advantages and Disadvantages of Open and Closed Technique?
		14.2.7	 What Is the Choice of Chemotherapeutic Drug and Drug Dosaging for HIPEC? What Are its Implications on Perioperative Period?
		14.2.8	 What Are Adverse Effects of Specific Chemotherapeutic Agents Used for HIPEC?
		14.2.9	 What Different Evaluations/Preoperative Risk Assessment Are Required for This Patient Apart from Routine Assessment?
		14.2.10 What Is the Role of Prehabilitation in This Patient?
		14.2.11 What Are the Anaesthetic Considerations for CRS + HIPEC?
		14.2.12 Enumerate the Physiological Alterations That May Occur During HIPEC, and Its Anaesthetic Implications
		14.2.13 What Risks Are Present During Induction of This Patient? How Are They Planned for?
		14.2.14 What Precautions/Premedications Would You Take Before Incision?
		14.2.15 Discuss the Various Intraoperative Monitoring Options
		14.2.16 Describe the Anaesthetic Drugs of Choice for This Procedure
		14.2.17 Discuss the Essential Principles for Fluid Management and Blood Product Transfusion in These Patients
		14.2.18 What Will Be Your Approach Towards Transfusion of Blood Products During This Surgery?
		14.2.19 Why Is It Important to Monitor Coagulation Status of These Patients in the Perioperative Period?
		14.2.20 What Is the Role of Monitoring Urine Output During This Surgery?
		14.2.21 Why Do We Need to Cautiously Monitor for Electrolyte Imbalance?
		14.2.22 Why Is Glycaemic Control Difficult in These Patients?
		14.2.23 Enumerate the Various Options for Intraoperative and Postoperative Analgesia
		14.2.24 Describe the Implications in Intraoperative Temperature Control
		14.2.25 Enumerate the Physiological Alterations and Its Implications in the Postoperative Period
		14.2.26 What Are the Occupational Safety Concerns for Professionals Involved in the Perioperative Care of This Patient?
	References
15: Hepatic Metastases for Right Hepatectomy
	15.1	 General Considerations
	15.2	 Preoperative Management of Liver Resection
	15.3	 Intraoperative Management of Liver Resection
	15.4	 Postoperative Management
	References
16: Ca Rectum for Laparoscopic Abdomino-Perineal Resection
	16.1	 Case Scenario
	References
17: CA Osteosarcoma for Below-Knee Amputation
	17.1	 Introduction
	17.2	 Psychological Evaluation
	17.3	 Perioperative Antibiotics
	17.4	 Premedication
	17.5	 Positioning
	References
18: Anaesthesia for Bone Marrow Aspiration and Biopsy
	18.1	 Case
	18.2	 What Is BMA and BMB?
	18.3	 What Are the Indications of Bone Marrow Aspiration (BMA) [1]?
	18.4	 What Are the Indications of Bone Marrow Biopsy (BMB)?
	18.5	 What Are the Contraindications for BMA and BMB?
	18.6	 How It Is Performed?
	18.7	 What Are the Complications?
	18.8	 Need for Anaesthesia during BMA and BMB
	18.9	 How Will You Do the Pre-anesthetic Evaluation?
	18.10	 Care of Immunocompromised Child
		18.10.1 Strict Aseptic Measures
		18.10.2 Care of Central Venous Lines
	18.11	 What Are the Goals of Anaesthesia?
	18.12	 What Anaesthesia Is Used for BMA and BMB?
		18.12.1 Adults
	18.13	 Post Procedure Care
	References
19: Paediatric Case of Medulloblastoma for Whole Brain Radiotherapy
	19.1	 Case Vignette
	References
20: Anaesthetic Considerations for a Patient with Carcinoma Prostate Planned for Brachytherapy
	20.1	 Case Vignette
	20.2	 Introduction
	20.3	 Pre-procedural Concerns: Patient-Related Factors
	20.4	 Intra-procedural Concerns: Procedure-Related, Positioning, Anaesthetic Options
	20.5	 Post-procedural Concerns: Analgesia, Resuming Normal Activities and Discharge
	References
21: Wilms Tumour
	21.1	 Case Scenario
	References
22: Paediatric Case of Mediastinal Mass for USG-/CT-Guided Biopsy
	22.1	 Case Scenario
	22.2	 Give an Overview of Mediastinal Masses
	22.3	 What Are the Clinical Presentation of Children with Mediastinal Mass?
	22.4	 What Are the Predictors of Acute Perioperative Cardiorespiratory Complications in Patients with Anterior Mediastinal Mass? (Table 22.1)
	22.5	 How Do You Risk Stratify These Patients?
	22.6	 Describe the Pre-operative Management of Mediastinal Mass
	22.7	 What Are the Mechanisms by Which General Anaesthesia Causes Cardiorespiratory Collapse in a Patient with Anterior Mediastinal Mass?
	22.8	 What Is the Post Procedural Management of These Cases?
	22.9	 What Are the Complications of This Procedure?
	References
23: Unresectable Carcinoma Gall Bladder for Percutaneous Transhepatic Biliary Drainage
	23.1	 Case Study
	23.2	 What Is the Worldwide Incidence of Carcinoma Gall Bladder [1]?
	23.3	 Discuss Epidemiology of CAGB in India
	23.4	 Describe in Brief the Pathophysiology and Risk Factors for CAGB [3, 7, 8]
		23.4.1	 Anatomical Factors
		23.4.2	 Geographic or Environmental Factors
		23.4.3	 Dietary Factors
		23.4.4	 Others
	23.5	 Discuss Clinical Presentation and Staging of CAGB [3, 8]
	23.6	 What Are Presenting Symptoms of CAGB [4, 14]?
	23.7	 What Are the Diagnostic Modalities for Diagnosis of CAGB [8, 16, 17]?
	23.8	 Common Symptoms Associated with Advanced CAGB [18, 19]
	23.9	 What Are Current Treatment Options Available for CAGB [20]
		23.9.1	 Adjuvant Treatments
	23.10	 What Are Modalities of Palliation for Obstructive Jaundice in Advanced or Unresectable CAGB [19]
	23.11	 What Is the Procedure of PTBD and Its Benefits and Uses. Describe the Procedure of PTBD [29]
	23.12	 What Are the Types of PTBD?
	23.13	 What Are the Available Approaches for PTBD?
	23.14	 What Is Percutaneous SEMS?
	23.15	 What Are the Possible Complications During PTBD?
	23.16	 What Are Other Alternatives to Achieve Biliary Drainage Apart from PTBD [18, 32, 33]?
	23.17	 What Is the Evidence for Utility of EUS-BD [34]?
	References
24: Case of Liver Metastasis for RFA
	24.1	 Case History
	24.2	 Introduction
	24.3	 What Are the Different Modalities of Treatment for Liver Metastasis?
	24.4	 What Is RFA?
	24.5	 What Are the Advantages of RFA?
	24.6	 How RFA Performed?
	24.7	 Indication of Liver RFA?
	24.8	 Limitations of RFA
	24.9	 What Are the Goals of Anaesthesia in a Patient Posted for Liver RFA?
	24.10	 What Are the Anaesthesia Concerns in RFA?
	24.11	 What Are Different Anaesthesia Techniques Used for Liver RFA?
	24.12	 The Minimum Monitoring Required for RFA?
	24.13	 Minimum Anaesthesia Equipment for PRFA Procedures
	24.14	 Enumerate the Complications of RFA
		24.14.1 Prognosis
	24.15	 Perioperative Antibiotic Prophylaxis
	References
25: Tumour Lysis Syndrome
	25.1	 Case History
	25.2	 Physical Examination
	25.3	 Renoprotective Measures
		25.3.1	 Rapid Expansion of Intravascular Volume
		25.3.2	 Diuresis
	25.4	 Correction of Electrolyte Imbalance
		25.4.1	 Hypocalcaemia
		25.4.2	 Hyperkalaemia
		25.4.3	 Hyperphosphataemia
		25.4.4	 Hyperuricaemia
			25.4.4.1	 Allopurinol
			25.4.4.2	 Recombinant Urate Oxidase (Rasburicase) [5, 18–20]
			25.4.4.3	 Febuxostat
			25.4.4.4	 Sodium Bicarbonate (Alkalisation of Urine) [1, 14–18]
			25.4.4.5	 Haemodialysis
	References
26: Carcinoma Base of the Tongue with Acute Stridor
	26.1	 Case
	26.2	 Cancer of the Base of the Tongue
	26.3	 Anaesthesia Considerations
		26.3.1	 Pre-op Considerations
		26.3.2	 Awake Fibreoptic Technique
		26.3.3	 Inhalational Induction
		26.3.4	 Anaesthesia for a Patient with Acute Stridor
		26.3.5	 History
			26.3.5.1	 Examination
	References
27: A Case of Carcinoma Colon with Febrile Neutropenia
	27.1	 Aetiology and Risk Factors
	27.2	 Screening
	27.3	 Prevention
		27.3.1	 Pathology
	27.4	 Signs and Symptoms
	27.5	 Diagnostic Workup
	27.6	 Prognostic and Risk Factors
		27.6.1	 Medical Therapeutic Modalities
	27.7	 The Febrile, Neutropenic Patient
	27.8	 Pathophysiology [1–5]
	27.9	 Radiologic Studies
	27.10	 Treatment [2, 4, 5, 8–12]
	References
28: CA Breast with Spinal Cord Compression
	28.1	 Case Scenario
	28.2	 What Is the Incidence and Common Symptoms of Presentation of Metastatic Spinal Cord Compression (MSCC) from Various Carcinoma?
	28.3	 How Do Patients with MSCC Present? What Are the Key Clinical Findings That Help Us to Diagnose?
	28.4	 Explain the Different Theories of Pathophysiology Behind the MSCC
	28.5	 What Are the Investigations Required to Diagnose the MSCC?
	28.6	 What Should Be Your Initial Plan of Management?
	28.7	 How Can the Patient with Suspected MSCC Be Positioned for Care?
	28.8	 What Is the Role and Dose of Glucocorticoids?
	28.9	 Which Modalities Are Available for Pain Relief?
	28.10	 When Will the Patient Be Considered a Candidate for Surgery?
	28.11	 Are There Any Objective Criteria to Decide Between Surgery and Radiotherapy?
	28.12	 When Is the Radiation Therapy Indicated?
	28.13	 What Is the Role of Bisphosphonates?
	28.14	 What Is the Role of Rehabilitation in These Patients?
	28.15	 What Thromboprophylaxis Measures Should Be Taken for These Patients?
	28.16	 How Will You Prevent Pressure Ulcers?
	28.17	 How to Manage Bladder and Bowel Continence?
	28.18	 How Will You Ensure Adequate Circulatory and Respiratory Functioning?
	28.19	 What Will Be Your Rehabilitation Plan After the Patient Is Discharged?
	28.20	 How to Evaluate Quality of Life (QoL) in These Patients?
	References
29: Ca Endometrium with Long-Standing Diabetes Mellitus for Radical Hysterectomy
	29.1	 Case Scenario
	References
30: Anaesthetic Considerations for a Child with Retinoblastoma for Orbital Enucleation
	30.1	 Case History
	30.2	 Introduction
		30.2.1	 Primary Concerns
		30.2.2	 Preoperative Evaluation
		30.2.3	Anaesthesia Management
			30.2.3.1 Premedication
			30.2.3.2	 Induction of Anaesthesia
			30.2.3.3	 Airway Management
			30.2.3.4	 Maintenance of Anaesthesia
			30.2.3.5	 Oculocardiac Reflex (OCR)
			30.2.3.6	 Intraoperative Analgesia
				Postoperative Care
	References
31: Anaesthesia for Central Airway Obstruction
	31.1	 What Are the Causes of Central Airway Obstruction (CAO)?
	31.2	 Describe the Airway Stents
	31.3	 What Are the Complications of Airway Stenting?
	31.4	 What Are the Anaesthetic Considerations in this Procedure?
	31.5	 What Are the Local and Systemic Effects of Malignancy that Can Have Anaesthetic Implications?
		31.5.1	 Systemic Effects [19]
		31.5.2	 Local Effects [19]
	31.6	 What Pre-Procedural Preparation Can Be Done Before the Bronchoscopy?
	31.7	 What Are the Anaesthetic Considerations for Rigid Bronchoscopy?
	31.8	 What Are the Anaesthetic Techniques that Can Be Used in These Procedures?
		31.8.1	 Induction of Anaesthesia
		31.8.2	 Maintenance of Anaesthesia
	31.9	 What Are the Anaesthetic Considerations in Patients with an Airway Stent Posted for Unrelated Procedures?
	31.10	 What Are the Modes of Ventilation that Can Be Used During Rigid Bronchoscope Procedures?
	References
32: Anaesthetic Management of Pheochromocytoma
	32.1	 Case History
	32.2	 What Is Pheochromocytoma?
	32.3	 Case
	32.4	 What Are the Signs and Symptoms of Pheochromocytoma? [1, 2]
	32.5	 What Is the Mechanism of Orthostatic Hypotension?
	32.6	 What Is Catecholamine-Induced Cardiomyopathy?
	32.7	 How Will You Confirm your Diagnosis?
		32.7.1	 Biochemical Tests
		32.7.2	 Imaging Studies
	32.8	 How Will You Evaluate and Optimise this Patient for the Surgery?
		32.8.1	 Evaluation
		32.8.2	 Optimisation
	32.9	 Why Is it Necessary to Initiate Alpha-Blockade in These Patients?
	32.10	 Why Should Alpha-Blockade Be Initiated before Beta-Blockade?
	32.11	 What Are the Drugs Used to Control the Blood Pressure? (Table 32.5)
	32.12	 How Will the Surgical Technique Affect your Anaesthesia Choices?
		32.12.1 What Are your Anaesthetic Considerations?
	32.13	 What Is the Aetiology of Intraoperative Hypotension?
	32.14	 How Will you Monitor the Patient Intraoperatively?
	32.15	 Are Arterial Pulse Contour Analysis Devices Useful in Pheochromocytoma Surgery?
	32.16	 What Are the Postoperative Complications?
	32.17	 How Will you Manage a Pheochromocytoma Which has Been Incidentally Detected During Routine Surgery?
	32.18	 How Will You Manage a Patient Who Is Diagnosed with a Pheochromocytoma During Pregnancy?
	References
33: A Case of Carcinoma Breast with Brain Metastasis for Gamma Knife Radiosurgery
	33.1	 Case History
	33.2	 What Are the Various Types of Breast Cancer? What Are the Risk Factors and Its Manifestations?
	33.3	 What Are the Common Sites and Symptoms of Metastasis in Patients of Breast Cancer?
	33.4	 What Are the Incidence, Prognosis, and Risk Factors for Brain Metastasis in Patients of Breast Cancer?
	33.5	 What Are the Treatment Options and Prognosis After Treatment for Brain Metastasis in Breast Cancer Patients?
	33.6	 What Is Stereotactic Radiosurgery?
	33.7	 Enumerate the Advantages of SRS
	33.8	 What Are the Indications and Contraindications for SRS in Breast Cancer Patients with Brain Metastasis?
	33.9	 How Is a Patient Evaluated and Prepared for Gamma Knife Radiosurgery?
	33.10	 What Is the Workflow of Treatment for the Patient Posted for Gamma Knife Radiosurgery?
	33.11	 What Are the Local Anesthetic Drugs that Can Be Used for Placement of the Stereotactic Frame?
	33.12	 How Is the Patient Monitored and Positioned During the Procedure?
	33.13	 What Are the Anesthetic Considerations before Taking a Patient for Gamma Knife Surgery?
	33.14	 How Is Monitored Anesthesia Care (MAC) Provided for Gamma Knife Surgery?
		33.14.1 Procedure
		33.14.2 Discharge
		33.14.3 Follow-Up
	33.15	 What Are the Indications of General Anesthesia for Gamma Knife Radiosurgery and How Is It Accomplished?
		33.15.1 Induction
		33.15.2 Maintenance
		33.15.3 Extubation and Recovery
	33.16	 What Are the Complications Associated with Gamma Knife Treatment?
	References
34: Case of Carcinoma Urinary Bladder for Proton Radiation Therapy
	34.1	 How Is the Cancer Burden in the World?
	34.2	 What Is the Incidence of Urinary Bladder Cancer?
	34.3	 Who Are more Affected with Urinary Bladder Cancer?
	34.4	 What Are the Risk Factors of Bladder Cancer?
	34.5	 How Does Bladder Cancer Patients Present?
	34.6	 What Are the Common Sites of Metastasis of Bladder Cancer?
	34.7	 What Are Different Types of Bladder Cancer and their Prognosis?
	34.8	 What Is the Prognosis of Different Types of Bladder Cancer?
	34.9	 What Are the Various Management Options for Bladder Cancer?
	34.10	 What Is Proton Radiation Therapy (PBT)?
	34.11	 What Are the Advantages of Proton Radiation Therapy?
	34.12	 What Are the Side Effects of PBT?
	34.13	 What Are the Anesthetic Considerations in Patients Posted for Proton Radiation Therapy?
	34.14	 What Challenges an Anesthesiologist Face in an Outside Operating Room Environment?
	34.15	 What Are the Patient-Related Concerns?
	34.16	 What Positional Care Should Be Taken by Anesthesiologist During Proton Beam Radiotherapy in Other Tumors?
	34.17	 What Are the Implications of Tight-Fitting Immobilization Face Mask During Proton Therapy?
	34.18	 Discuss the Pain and Palliative Care Management Strategies for Urinary Bladder Cancer Patient
	34.19	 What Are the Domains Where Bladder Cancer Patients Need Care?
	References
35: Case of Ca Lung for EBUS and TBNA
	35.1	 Discuss the Basic Principles of Bronchoscopy
	35.2	 What Are the Equipment and Techniques Utilized for EBUS
		35.2.1	 Basic Description of EBUS
	35.3	 What Are Physiological Effects of Bronchoscopy?
	35.4	 What Are the Indications of EBUS?
	35.5	 Discuss the Preoperative Evaluation and Optimization of Patients Posted for EBUS
	35.6	 Discuss the Preparation and Safety Required for the Conduct of EBUS Procedure
	35.7	 What Is the Anesthesia Technique Practiced for the Conduct of EBUS?
	35.8	 What All Modalities Are Available for Maintenance of Anesthesia?
	35.9	 Discuss the Monitoring Techniques for the Procedure
	35.10	 What All Oxygenation and Ventilation Strategies Can Be Utilized for EBUS?
	35.11	 What Are the Complications of EBUS Procedure?
	35.12	 What Are the Contraindications of EBUS?
	35.13	 What Are the Limitations of EBUS?
	35.14	 Briefly Describe the Postoperative Care
	References
36: Anesthesia and Cancer Recurrence
	36.1	 Case Scenario
	36.2	 What Are the Common Survival Metrics Measured in Cancer Patients?
	36.3	 Briefly Summarize the Immunological Viewpoint of Cancer Recurrence
	36.4	 How Do the Commonly Used Anesthetic Agents Affect the Immune System?
	36.5	 Based on Available Evidence, How Are the Anesthetic Agents and Anesthetic Techniques Implicated in Cancer Recurrence?
	36.6	 Apart from Immunomodulation, How Does Perioperative Anesthesia Care Affect Long-term Oncological Outcomes?
	36.7	 Given the Equivocal Evidence for Anesthesia and Cancer Recurrence, What Should the Perioperative Plan of Action Be?
	36.8	 How Will you Approach the Patient Given in the Case Scenario?
	References