Textbook of Onco-Anesthesiology

Preface
Contents
Editors and Contributors
About the Editors
Section Editors
Contributors
Part I: Introduction
	1: Need for Onco-Anesthesia as Super Specialty
		1.1	 Introduction
		1.2	 The Need
		1.3	 Onco-Anesthesiology as a Separate Specialty: Present Scenario
		1.4	 At All India Institute of Medical Sciences (AIIMS)
		1.5	 Future Prospects
		1.6	 Summary
		References
	2: Epidemiology of Cancer
		2.1	 Introduction
		2.2	 Definition of Cancer Epidemiology
		2.3	 Role of Cancer Epidemiology in Healthcare Improvement
		2.4	 Molecular Epidemiology
		2.5	 Sources of Cancer Data
		2.6	 Cancer Statistics
		2.7	 Conclusion
		References
	3: Anesthesia and Cancer Recurrence
		3.1	 Introduction
		3.2	 Cancer Biology
		3.3	 Effect of Surgery on Cancer
		3.4	 Effects of Anesthetic Techniques and Drugs on Cancer
		3.5	 General Factors
		3.6	 Specific Agents and Techniques Used in Anesthesia and Their Influence on Cancer
		3.7	 Intravenous Anesthetic Agents
		3.8	 Regional Anesthesia
		References
Part II: Basics of Onco-Anaesthesiology
	4: Anaesthetic Implications of Chemotherapy and Radiotherapy
		4.1	 Introduction
		4.2	 Concerns in the Preoperative Period Due to Cancer Therapy
		4.3	 Basic Principles of Chemotherapy
		4.4	 Chemotherapeutic Agents
			4.4.1	 Anti-tumour Antibiotics
				4.4.1.1	 Anthracyclines
				4.4.1.2	 Bleomycin
				4.4.1.3	 Mitomycin C
			4.4.2	 Alkylating Agents
			4.4.3	 Anti-metabolites
				4.4.3.1	 Methotrexate
				4.4.3.2	 5-Fluorouracil
			4.4.4	 Cisplatin and Analogues
			4.4.5	 Anti-microtubule Agents
				4.4.5.1	 Vinca Alkaloids: Vincristine, Vinblastine
				4.4.5.2	 Taxanes: Paclitaxel, Docetaxel
			4.4.6	 Topoisomerase II Inhibitors: Etoposide, Teniposide
		4.5	 Systems Wise Approach to Pre-anaesthetic Assessment and Management
			4.5.1	 Cardiovascular System
				4.5.1.1	 Preoperative Assessment
				4.5.1.2	 Perioperative Management
			4.5.2	 Respiratory System
				4.5.2.1	 Preoperative Evaluation
			4.5.3	 Gastrointestinal System
			4.5.4	 Renal System
				4.5.4.1	 Perioperative Implications
			4.5.5	 Nervous System
			4.5.6	 Haematopoetic System
		4.6	 Anaesthetic Effects of Radiation Therapy
			4.6.1	 Basic Principles of Radiation Therapy (RT)
				4.6.1.1	 Adverse Effects of Radiation [57, 58]
				4.6.1.2	 Airway Changes Due to Radiation [59, 60]
				4.6.1.3	 Pulmonary Effects of Radiation [61, 62]
				4.6.1.4	 Cardiac Effects of Radiotherapy [63, 64]
		4.7	 Summary
		References
	5: Preoperative Assessment and Optimization of the Cancer Patient for Onco-Surgery
		5.1	 Introduction
		5.2	 Global Assessment of the Cancer Patient
			5.2.1	 Cardiovascular Assessment
			5.2.2	 Pulmonary Assessment
			5.2.3	 Neurological Assessment
			5.2.4	 Renal Assessment
			5.2.5	 Airway Assessment
		5.3	 Risk Stratification and Prognostication
			5.3.1	 Prehabilitation
				5.3.1.1	 Physical Activity
				5.3.1.2	 Nutrition
				5.3.1.3	 Anemia Correction
				5.3.1.4	 Smoking/Alcohol Cessation
				5.3.1.5	 Stress Management
			5.3.2	 Cardiopulmonary Exercise Testing (CPET)
		5.4	 Summary
		References
	6: Prehabilitation for Onco-Anesthesiology
		6.1	 Introduction
		6.2	 Preoperative Exercise Program
			6.2.1	 Rationale
			6.2.2	 Method of Assessing Functional Capacity/Fitness
			6.2.3	 Exercise Strategies
		6.3	 Nutritional Support
			6.3.1	 Nutritional Assessment
			6.3.2	 Nutrition Goal
		6.4	 Anemia
		6.5	 Conclusion
		References
	7: Airway Management in Cancer Patients
		7.1	 Introduction
		7.2	 Reasons for Difficult Airway in Cancer Patients
		7.3	 Types of Airway Difficulties in Cancer Patients
		7.4	 Planning Airway Management in Cancer Patients
			7.4.1	 Airway Assessment of Cancer Patients
				7.4.1.1	 Focused History
				7.4.1.2	 Focused General Physical Examination
				7.4.1.3	 AMF “Line of sight” Airway Examination
			7.4.2	 Optimization of Areas Deemed “Difficult” During Airway Assessment in Cancer Patients
			7.4.3	 Review of Surgical Requirements
			7.4.4	 Means of Maintaining Good Oxygenation
			7.4.5	 Making Main and Subsidiary Plans
		7.5	 Summary
		References
	8: Drugs, Fluids and Cancer
		8.1	 Introduction
		8.2	 Effects of Surgery
		8.3	 Anesthetic Agents
		8.4	 Analgesics
		8.5	 Local Anesthetic Agents And Neuro-muscular Blocking Agents
		8.6	 Effect of Other Perioperative Factors
			8.6.1	 Hypothermia
			8.6.2	 Blood Transfusion
			8.6.3	 Other Perioperative Factors
		8.7	 Anesthetic Technique
			8.7.1	 Role of Regional Anesthesia or Analgesia
			8.7.2	 Propofol Versus Inhalational Anesthesia
		8.8	 Fluids and Cancer
			8.8.1	 General Principles
			8.8.2	 Perioperative Management of Fluids in Cancer Surgeries
				8.8.2.1	 Preoperative Fluids
					Enhanced recovery after surgery
				8.8.2.2	 Intraoperative Fluids
				8.8.2.3	 Postoperative Fluids
		8.9	 Summary
		References
Part III: Specialty Anaesthesiology for Cancers
	9: Anesthesia for Oral Cancer Surgery
		9.1	 Introduction
		9.2	 Applied Anatomy of the Oral Airway
		9.3	 Oral Cancer Surgery
		9.4	 Glossectomy
		9.5	 Mandibulectomy
		9.6	 Maxillectomy
		9.7	 Floor of Mouth (FOM) Excision
		9.8	 Bite Composite Resections
		9.9	 Concerns for Anesthesia
			9.9.1	 Airway
			9.9.2	 Nutrition and Anemia
			9.9.3	 Effects of Previous Chemotherapy
			9.9.4	 Comorbidities
			9.9.5	 Intra-operative Blood Loss
			9.9.6	 Hypothermia
		9.10	 Pre-operative Assessment and Optimization
			9.10.1	 Airway Assessment
				9.10.1.1	 Facial Defects
				9.10.1.2	 Evaluation of Trismus
				9.10.1.3	 Oral Cavity Examination
					Size, Site, and Extent of Tumor
					Ankyloglossia
					The Base of Tongue Involvement
					Dentition and Oral Hygiene
				9.10.1.4	 Intra-nasal Examination
				9.10.1.5	 Previous Radiation Therapy
				9.10.1.6	 Role of Imaging and Previous Airway Examination Findings
				9.10.1.7	 Virtual Endoscopy
				9.10.1.8	 Previous Awake Airway Assessment Findings
			9.10.2	 Nutrition and Anemia
			9.10.3	 Effects of Tobacco Chewing and Smoking
			9.10.4	 Effect of Chemotherapy
			9.10.5	 Pre-operative Pain Management
		9.11	 Intra-operative Management
			9.11.1	 Pre-medication
			9.11.2	 Monitoring
			9.11.3	 Role of Peri-intubation Oxygenation
			9.11.4	 General Anesthesia
			9.11.5	 Securing the Airway
			9.11.6	 Awake Intubation
				9.11.6.1	 Pre-medication for Awake Intubation
				9.11.6.2	 Methods of Anesthetizing the Airway for Awake Intubation
				9.11.6.3	 Types of Awake Intubation
					Intubation with using a Flexible Broncoscope (FB)
					Retrograde Intubation
					Blind Nasal Intubation
					Awake Video Laryngoscopy (VL)
					Nasal Endotracheal Tubes
			9.11.7	 General Measures
			9.11.8	 Fluid Management
			9.11.9	 Intra-operative Analgesia
				9.11.9.1	 Nerve Blocks
			9.11.10 Intra-operative Airway Management
				9.11.10.1	 Intra-operative Loss of Airway
		9.12	 Post-operative Management
			9.12.1	 Post-operative Airway Management
				9.12.1.1	 Sedation
				9.12.1.2	 Humidification
				9.12.1.3	 Extubation
				9.12.1.4	 Assessing and Treating Airway Edema
				9.12.1.5	 Performing Extubation
				9.12.1.6	 Use of Airway Exchange Catheters
			9.12.2	 Nutrition
			9.12.3	 Rehabilitation
			9.12.4	 Post-operative Pain Management
			9.12.5	 Enhanced Recovery After Surgery (ERAS)
			9.12.6	 Post-operative Complications
		9.13	 Care of the Patient with a Tracheostomy
			9.13.1	 Daily Checks by Nursing Staff
			9.13.2	 Humidification
			9.13.3	 Suctioning
			9.13.4	 Assessment of a Patient with a Tracheostomy Inwards
			9.13.5	 Equipment to Be Kept at the Bedside of a Patient with a Tracheostomy
			9.13.6	 Obstructed Tracheostomy Tube
		9.14	 Summary
		References
	10: Anaesthesia for Head and Neck Cancer Surgeries
		10.1	 Introduction
		10.2	 Preoperative Assessment
			10.2.1	 Airway Assessment
		10.3	 Risk Stratification and Optimization of Comorbidities
		10.4	 Operative Laryngoscopy and Microlaryngeal Surgery
			10.4.1	 Airway Concerns for Microlaryngeal Surgery (MLS)
				10.4.1.1	 Airway Management
		10.5	 Intraoperative Ventilation Strategies for MLS
			10.5.1	 MLS Under Conscious Sedation
			10.5.2	 MLS Under General Anesthesia
			10.5.3	 General Anesthetic Management for MLS
			10.5.4	 Anesthesia Induction and Maintenance
			10.5.5	 Extubation and Emergence from Anesthesia
		10.6	 Postoperative Airway Problems
		10.7	 Anaesthetic Management for Laser Airway Surgeries
		10.8	 Laser Hazards
		10.9	 Preventing Airway Fires
			10.9.1	 Airway Fire Management During Laser Surgery
		10.10	 Anaesthetic Management of Laryngectomy
			10.10.1 Intraoperative Management
		10.11	 Juvenile Nasopharyngeal Angiofibroma (JNA)
			10.11.1 Clinical Presentation
			10.11.2 Anesthetic Consideration
			10.11.3 Preoperative Blood Conservation Strategies
				10.11.3.1	 Anaesthetic Management
			10.11.4 Various Strategies Employed to Decrease Intraoperative Loss
			10.11.5 Intracranial Extension of JNA
			10.11.6 Extubation of Trachea
		10.12	 Summary
		References
	11: Anesthesia for Lung Cancers
		11.1	 Introduction
		11.2	 Non-small Cell Lung Cancer (NSCLC)
		11.3	 Small Cell Lung Cancer (SCLC)
		11.4	 Carcinoid Tumors
		11.5	 Pleural Tumors
		11.6	 Preoperative Assessment
			11.6.1	 Assessment of Lung Cancer
			11.6.2	 Assessment of Respiratory Function Before Lung Resection
				11.6.2.1	 Lung Mechanical Function
				11.6.2.2	 Parenchymal Lung Function
				11.6.2.3	 Cardiopulmonary Interaction
				11.6.2.4	 Ventilation Perfusion Scintigraphy
		11.7	 Intraoperative Monitoring
			11.7.1	 Oxygenation
			11.7.2	 Capnometry
			11.7.3	 Arterial Line
			11.7.4	 Central Venous Line
			11.7.5	 Pulmonary Artery Catheters
			11.7.6	 Fiberoptic Bronchoscopy
			11.7.7	 Continuous Spirometry
			11.7.8	 Transesophageal Echocardiography (TEE)
		11.8	 Lung Isolation
			11.8.1	 Double-Lumen Tubes
				11.8.1.1	 Size Selection
				11.8.1.2	 DLT Placement Method
				11.8.1.3	 Right-Sided Double-Lumen Tubes
			11.8.2	 Bronchial Blockers
			11.8.3	 Endobronchial Tubes
			11.8.4	 Difficult Airways and Lung Isolation
			11.8.5	 Summary
		11.9	 One-Lung Ventilation
			11.9.1	 Hypoxic Pulmonary Vasoconstriction (HPV)
			11.9.2	 Acute Lung Injury
			11.9.3	 Tidal Volumes
			11.9.4	 Positive End Expiratory Pressure (PEEP)
			11.9.5	 Airway Pressures
			11.9.6	 Alveolar Recruitment Maneuvers (ARM)
			11.9.7	 Fraction of Inspired Oxygen (FIO2)
			11.9.8	 Ventilation Mode
			11.9.9	 Maintenance of Anesthesia
			11.9.10 Postoperative Care
			11.9.11 Hypoxemia During One-Lung Ventilation
		11.10	 Intravenous Fluid Management
		11.11	 Surgical Procedures
			11.11.1 Flexible Fiberoptic Bronchoscopy
			11.11.2 Rigid Bronchoscopy
			11.11.3 Mediastinoscopy
			11.11.4 Endobronchial Ultrasound-Guided Biopsy
			11.11.5 Minimally Invasive Thoracoscopic Surgery
			11.11.6 Robotic-Assisted Thoracic Surgery
			11.11.7 Lobectomy
			11.11.8 Pneumonectomy
			11.11.9 Limited Pulmonary Resections: Segmentectomy and Wedge Resection
		11.12	 Postoperative Analgesia
			11.12.1 Systemic Medications
				11.12.1.1	 Opioids
				11.12.1.2	 Non-steroidal Anti-inflammatory Drugs (NSAIDs)
				11.12.1.3	 Ketamine
			11.12.2 Local Anesthetic Drugs and Regional Nerve Blocks
				11.12.2.1	 Intercostal Nerve Blocks
				11.12.2.2	 Epidural Analgesia
				11.12.2.3	 Paravertebral Block
				11.12.2.4	 Erector Spinae Plane (ESP) Block
			11.12.3 Postoperative Pain Management Problems
				11.12.3.1	 Shoulder Pain
				11.12.3.2	 Opioid Tolerant Patients
			11.12.4 Postoperative Complications
				11.12.4.1	 Empyema
				11.12.4.2	 Bronchopleural Fistula
				11.12.4.3	 Atrial Fibrillation
				11.12.4.4	 Cardiac Herniation
		11.13	 Summary
		References
	12: Anesthesia for Esophageal Cancer Surgeries
		12.1	 Introduction
		12.2	 Epidemiology
		12.3	 Risk Factors and Pathophysiology
		12.4	 Preoperative Assessment
		12.5	 Anesthesia Technique
		12.6	 Monitoring
		12.7	 Postoperative Course
		12.8	 Enhanced Recovery After Surgery
		12.9	 Evolution of Surgical Technique
		12.10	 Summary
		References
	13: Autologous Free-Flap Reconstruction After Oncosurgery
		13.1	 Introduction
		13.2	 Surgical Concepts
		13.3	 Pathological Concepts Associated with Free-Flap Complications
		13.4	 Physiology of Flap Perfusion and Relevant Perioperative Factors
		13.5	 Strategies for Hemodynamic Optimization
			13.5.1	 Preoperative Carbohydrate Drinks
			13.5.2	 Goal-Directed Therapy (GDT)
			13.5.3	 Vasoactive and Inotropic Drugs
			13.5.4	 Therapies Targeting the Endothelial Glycocalyx
		13.6	 Perioperative Considerations for Microvascular Free-Flap Transfer Procedures
			13.6.1	 Preoperative Considerations: Identification and Optimization of Risk Factors Associated with Poor Flap Outcomes
				13.6.1.1	 Smoking and Nicotine Replacement Therapy
				13.6.1.2	 Diabetes Mellitus and HbA1C
				13.6.1.3	 Radiotherapy
				13.6.1.4	 Anemia
				13.6.1.5	 Malnutrition
				13.6.1.6	 Surgery-Specific Considerations
					Autologous Breast Reconstruction
					Adjuvant Therapies
					Head and Neck Cancer Resection with Immediate Flap Reconstruction
			13.6.2	 Intraoperative Considerations
				13.6.2.1	 Patient Positioning and Pressure Care
				13.6.2.2	 Surgical Equipment
				13.6.2.3	 Monitoring
				13.6.2.4	 Anesthetic Maintenance
				13.6.2.5	 Multimodal Analgesia
				13.6.2.6	 Postoperative Nausea and Vomiting (PONV)
				13.6.2.7	 Temperature Management
				13.6.2.8	 Venous Thromboembolism Prevention
				13.6.2.9	 Antibiotic Regimen
			13.6.3	 Postoperative Considerations
				13.6.3.1	 Anesthetic Emergence
				13.6.3.2	 Optimization of Flap Perfusion
				13.6.3.3	 Postoperative Flap Monitoring
				13.6.3.4	 Pulmonary Function and Early Mobilization
		13.7	 Summary
		References
	14: Anesthesia for Gastrointestinal Cancer Surgeries
		14.1	 Introduction
		14.2	 Overview of Preoperative Assessment, Anesthesia, and Pain Management for Bowel Surgery
		14.3	 Anesthesia for Gastric Cancers
		14.4	 Anesthesia for Cancer of the Small Intestine
		14.5	 Carcinoma of the Large Intestine
		14.6	 Colon Cancers
		14.7	 Carcinoma Rectum
		14.8	 Summary
		References
	15: Anesthesia for Hepatobiliary Cancers
		15.1	 Introduction
		15.2	 Preoperative Evaluation
		15.3	 Preoperative Holding Area
		15.4	 Intraoperative Management
		15.5	 Pain Management
			15.5.1	 Acetaminophen
			15.5.2	 Nonsteroidal Anti-inflammatory Drugs
			15.5.3	 Opioids
		15.6	 Summary
		References
	16: Anaesthesia for Breast Onco-surgeries and Reconstruction
		16.1	 Introduction
		16.2	 Anatomy
		16.3	 Types of Breast Cancer Surgery
			16.3.1	 Mastectomy
			16.3.2	 Wide Local Excision and Lumpectomy
			16.3.3	 Sentinel Lymph Node Biopsy
			16.3.4	 Axillary Dissection
		16.4	 Types of Breast Reconstructive Surgery
			16.4.1	 Implant-Based Reconstruction
			16.4.2	 Flap-Based Reconstruction
		16.5	 Preoperative Assessment
			16.5.1	 General Consideration
			16.5.2	 Anxiety and Premedication
			16.5.3	 Neoadjuvant Therapy Consideration: Chemotherapy
			16.5.4	 Neoadjuvant Therapy Consideration: Radiotherapy
		16.6	 Intraoperative Care
		16.7	 General Anaesthesia
			16.7.1	 Positioning
		16.8	 Analgesia
		16.9	 Regional Anaesthesia and Analgesia
			16.9.1	 Local Anaesthetic Infiltration
			16.9.2	 Pecs Block
			16.9.3	 Pecs Block Supplementation
				16.9.3.1	 Serratus Anterior Block
				16.9.3.2	 Transversus Thoracic Plane Block
			16.9.4	 Paravertebral Blockade
			16.9.5	 Thoracic Epidural
		16.10	 Systemic Analgesia
			16.10.1	 Opioids
			16.10.2	 Paracetamol and NSAIDs
			16.10.3	 Systemic Analgesia Adjuncts
		16.11	 Postoperative Care
		References
	17: Anesthetic Concerns in Endocrine Cancers
		17.1	 Introduction
		17.2	 Craniopharyngioma
			17.2.1	 Anesthetic Management
			17.2.2	 Postoperative Management
		17.3	 Adrenocortical Tumors
			17.3.1	 Preoperative Optimization
			17.3.2	 Induction and Maintenance of Anesthesia
			17.3.3	 Monitoring and Ventilator Management
			17.3.4	 Surgical Approach
			17.3.5	 Analgesia
		17.4	 Malignant Adrenal Medullary Tumors: Malignant Pheochromocytomas
			17.4.1	 Presentation
			17.4.2	 Investigations
			17.4.3	 Preoperative Optimization
			17.4.4	 Induction and Maintenance of Anesthesia
			17.4.5	 Intraoperative Hypertension
			17.4.6	 Management of Hypertensive Crisis
			17.4.7	 Postoperative Concerns
		17.5	 Malignant Carcinoid and Carcinoid Syndrome
			17.5.1	 Clinical Features
			17.5.2	 Investigations
			17.5.3	 Preoperative Assessment
			17.5.4	 Preoperative Optimization
			17.5.5	 Anesthetic Management and Treatment of Intraoperative Carcinoid Crisis
		17.6	 Insulinomas
			17.6.1	 Anesthetic Concerns
		17.7	 Parathyroid Tumors
			17.7.1	 Anesthetic Management of Parathyroidectomy
		17.8	 Summary
		References
	18: Anesthesia for Gynecological and Urological Cancer Surgery
		18.1	 Introduction
		18.2	 General Overview of Peri-anesthetic Management in Urogynecological Cancer Onco-surgery
		18.3	 Urological Cancers
			18.3.1	 Anesthesia for Radical Prostatectomy
			18.3.2	 Anesthesia for Radical Cystectomy
			18.3.3	 Anesthesia for Radical Nephrectomy
			18.3.4	 Anesthesia for Carcinoma Urethra
			18.3.5	 Anesthesia for Testicular Cancer Surgery
			18.3.6	 Anesthesia for Cancer of the Penis/Vulva
		18.4	 Gynecological Cancers
			18.4.1	 Anesthesia for Surgery of Carcinoma of the Cervix
			18.4.2	 Anesthesia for Endometrial Cancer
			18.4.3	 Anesthesia for Ovarian Cancer
		18.5	 Future Prospects
		18.6	 Summary
		References
	19: Anesthesia for Mediastinal Tumors
		19.1	 Introduction
		19.2	 Overview of Concerns for Mediastinal Tumors
		19.3	 Evaluation of the Patient
		19.4	 Investigations
		19.5	 Anesthesia Management
		19.6	 Anesthetic Concerns for Thoracic Robotic Surgery
		19.7	 Anesthetic Concerns in Pediatric Patients with a Mediastinal Mass
		References
	20: Anesthesia for Robotic Gynecologic and Urogenital Cancer Surgery
		20.1	 Introduction
			20.1.1	 Advancement in Robotic Surgery for Urology
			20.1.2	 General Anesthetic Considerations for Robotic Urologic and Gynecologic Onco-surgery
			20.1.3	 Effects of Steep Trendelenburg Position
			20.1.4	 Effects of Pneumoperitoneum
			20.1.5	 Effects of Prolonged Surgical Times and Positioning
			20.1.6	 Monitoring
			20.1.7	 Fluid Balance
			20.1.8	 Pain Management
			20.1.9	 Anesthesia for Robotic Radical Prostatectomy
			20.1.10 Anesthesia for Robotic Radical or Simple Nephrectomy
			20.1.11 Anesthesia for Robotic Radical Cystectomy
			20.1.12 Anesthesia for Robotic Adrenalectomy
			20.1.13 Anesthesia for Robotic RPLND (Retroperitoneal Lymph Node Dissection)
		20.2	 Anesthesia for Robotic-Assisted Gynecologic Surgery
			20.2.1	 Complications
		20.3	 Future Prospects
		20.4	 Summary
		References
	21: Anesthesia for Cardiac Tumors
		21.1	 Introduction
		21.2	 Epidemiology and Morphology
		21.3	 Tumor Classification Based on Location
		21.4	 General Clinical Features
		21.5	 Diagnosis
		21.6	 Surgical Management
		21.7	 Anesthetic Management
		21.8	 Cardiac Transplantation and Artificial Heart
		References
	22: Anesthesia for Brain Tumors
		22.1	 Introduction
			22.1.1	 Tumor Characteristics
			22.1.2	 Cerebral Autoregulation
			22.1.3	 Effect of Anesthetic Agents on Cerebral Blood Flow (CBF), Metabolism, and Autoregulation [6]
		22.2	 Preoperative Evaluation
			22.2.1	 History and Medical Examination
		22.3	 Planning for the Anesthesia
		22.4	 Positions During Neurosurgery
		22.5	 Anesthetic Management
		22.6	 Emergence from Anesthesia
		22.7	 Postoperative Care
		22.8	 Specific Scenarios
			22.8.1	 Posterior Fossa Tumor
		22.9	 Pituitary Adenoma
		22.10	 Awake Craniotomy
		22.11	 Ommaya Reservoir Placement
		22.12	 Tumor Resection Under Intraoperative MRI (iMRI) Guidance
		22.13	 Use of Tumor Dyes
		22.14	 Summary
		References
	23: Anesthesia for Spine Tumors
		23.1	 Introduction
			23.1.1	 Tumor Characteristics
			23.1.2	 Spinal Cord Blood Flow
		23.2	 Preoperative Evaluation
		23.3	 Plan for the Spine Surgical Procedure
		23.4	 Surgical Positioning
		23.5	 Anesthetic Management
			23.5.1	 Induction of Anesthesia
			23.5.2	 Maintenance of Anesthesia
			23.5.3	 Emergence from Anesthesia
		23.6	 Postoperative Care
		23.7	 Summary
		References
	24: Anesthesia for Pediatric Cancers
		24.1	 Introduction
		24.2	 Role of the Anesthesiologist
		24.3	 Preprocedural Evaluation
		24.4	 The Psychological Impact of the Disease
		24.5	 General Considerations in the Cancer Patient
			24.5.1	 Infection Control Measures
			24.5.2	 Tumor Lysis Syndrome
			24.5.3	 Management of Cancer Pain
		24.6	 Hematological Malignancies
		24.7	 Anesthesia for Short Procedures
			24.7.1	 Lumbar Puncture/Bone Marrow Biopsy
			24.7.2	 Long-Term Venous Access
			24.7.3	 Radiotherapy
			24.7.4	 Imaging: Magnetic Resonance Imaging (MRI), Ultrasonography (USG), and Computerized tomography (CT)
		24.8	 Anesthesia for Major Surgery
			24.8.1	 Abdominal Tumors
				24.8.1.1	 Nephroblastoma
					Clinical Presentation
					Anesthesia Challenges
					Preoperative Evaluation
					Perioperative Management
				24.8.1.2	 Hepatoblastoma
					Clinical Presentation
					Preoperative Evaluation
					Anesthesia Challenges
					Perioperative Management
				24.8.1.3	 Pheochromocytoma
					Clinical Presentation
					Diagnosis and Treatment
					Anesthesia Challenges
					Perioperative Management
			24.8.2	 Thoracic Tumors
				24.8.2.1	 Preoperative Evaluation
				24.8.2.2	 Anesthesia Challenges
				24.8.2.3	 Perioperative Management
			24.8.3	 Medulloblastoma
				24.8.3.1	 Anesthetic Challenges
				24.8.3.2	 Perioperative Management
				24.8.3.3	 Positioning
			24.8.4	 Sacrococcygeal Teratoma
				24.8.4.1	 Anesthesia Challenges
		24.9	 Anticancer Therapy and Its Anesthetic Implications
			24.9.1	 Oral Cavity and the Airway
			24.9.2	 Cardiac Toxicity
			24.9.3	 Pulmonary Toxicity
			24.9.4	 Renal Toxicity
			24.9.5	 Hepatic Function
			24.9.6	 Gastrointestinal Effects
			24.9.7	 Nervous System
			24.9.8	 Neuroendocrine System
			24.9.9	 Hematologic System
		24.10	 Summary
		References
	25: Anaesthesia for Video- and Robot-Assisted Onco-surgery
		25.1	 Introduction
		25.2	 Minimal Access Surgery Techniques and the Surgical Stress Response
		25.3	 Physiological Considerations for Laparoscopic Surgery
		25.4	 Preoperative Assessment and Suitability for the Laparoscopic Approach
		25.5	 Anaesthetic Strategies for Laparoscopic Cancer Surgery
		25.6	 Additional Considerations for Robotic Surgery
		References
	26: Anesthesia for Palliative Surgery
		26.1	 Introduction
		26.2	 Preoperative Evaluation
		26.3	 Specific Palliative Surgical Interventions
		26.4	 Conclusion
		References
Part IV: Analgesia for Onco-Surgery
	27: Perioperative Pain Management for Onco-surgery
		27.1	 Introduction
		27.2	 Preoperative Education
		27.3	 Preemptive Analgesia
		27.4	 Multimodal Analgesia
		27.5	 Regional Analgesia Techniques
		27.6	 Pharmacotherapy
		27.7	 Opioid-Sparing Strategies
		27.8	 Newer Drugs
		27.9	 Pain Management in Special Population
		27.10	 Opioid-Dependent Patient
		27.11	 The Multidisciplinary Role for Perioperative Pain Management
		27.12	 Summary
		References
Part V: Anaesthesia for Outside the Operating Room Procedures
	28: Anesthesia for Radiation Therapy Procedures
		28.1	 Introduction
		28.2	 Basic Principles
		28.3	 Anesthetic Challenges
		28.4	 Choice of Anesthesia or Sedation
		28.5	 Concerns During Simulation and Planning for RT
			28.5.1	 Pre-procedural Concerns
			28.5.2	 Intra-procedural Concerns
		28.6	 Intraoperative Radiotherapy (IORT)
		28.7	 Techniques of IORT
		28.8	 Unique Anesthetic Considerations of IORT (Fig. 28.4)
		28.9	 Intraoperative Monitoring
		28.10	 Anesthesia for Brachytherapy
		28.11	 Clinical Suitability for Brachytherapy
		28.12	 Role of Anaesthesiologist During Brachytherapy
		28.13	 Specific Anesthetic Concerns for Patients Undergoing Brachytherapy
		28.14	 Pre-anesthetic Evaluation
		28.15	 Monitoring
		28.16	 Anesthetic Techniques
		28.17	 Anesthesia for Cervical Brachytherapy
		28.18	 Anesthesia for Prostate Brachytherapy
		28.19	 Head and Neck Brachytherapy
		28.20	 Anesthesia for Accelerated Partial Breast Irradiation (APBI)
		28.21	 Post-procedural Care
		28.22	 Summary
		References
	29: Anaesthesia and Sedation for Radiological Imaging
		29.1	 Introduction
		29.2	 General Considerations
			29.2.1	 Computed Tomography (CT)
			29.2.2	 Magnetic Resonance Imaging (MRI)
				29.2.2.1	 Anesthetic Concerns Specific to MRI Suite
		29.3	 Anesthetic Management of Cancer Patients for CT/ MRI
			29.3.1	 Preoperative Assessment and Investigations
			29.3.2	 Staffing Requirements
			29.3.3	 Safety Requirements for Imaging Facilities with the Provision of Off-Site Anesthesia
			29.3.4	 Goals of Anesthesia
			29.3.5	 Indications of Anesthesia/Sedation
			29.3.6	 Monitoring
			29.3.7	 Monitoring and Equipment Concern Specific to MRI
			29.3.8	 Anesthetic Management of the Patient During CT/MRI
			29.3.9	 Equipment Check
			29.3.10 Airway Management Concerns for CT/MRI Anesthesia
			29.3.11 Anesthesia Techniques and Drugs
			29.3.12 Medications for Sedation and General Anesthesia
				29.3.12.1	 Newer Anesthetic/ Sedative Agents
			29.3.13 Target-Controlled Infusion (TCI)
			29.3.14 Patient-Controlled Sedation
			29.3.15 General Anesthesia (GA)
			29.3.16 Management of Emergencies in Radiation Suite
				29.3.16.1	 Management of Cardiopulmonary Collapse/ Arrest in MRI Suite
				29.3.16.2	 Adverse Reactions to Iodinated Contrast Media
				29.3.16.3	 Fire Emergency
				29.3.16.4	 Projectile Emergencies
				29.3.16.5	 Unintentional Quench
			29.3.17 Recovery Care
		29.4	 Summary
		References
	30: Anesthesia for Endoscopic Gastrointestinal Procedures
		30.1	 Introduction
		30.2	 Gastrointestinal Procedures an Overview
		30.3	 Pre-procedure Patient Valuation and Risk Stratification
		30.4	 Drugs Used for Sedation in Gastroenterology Suite
		30.5	 Drugs for the Future
		30.6	 Airway Devices Unique to Endoscopy
			30.6.1	 Patient Monitoring
			30.6.2	 Positioning the Patient
		30.7	 Sedation for Gastroenterology: Time for a Specialized Field
		30.8	 Summary
		References
	31: Anesthesia for Onco-Radiosurgery
		31.1	 Introduction
		31.2	 Stereotactic Radiosurgery Procedures
			31.2.1	 Perioperative Considerations
			31.2.2	 Choice of Anesthesia
			31.2.3	 Local Anesthesia
			31.2.4	 General Anesthesia
			31.2.5	 Anesthetic Management and Technical Challenges
		31.3	 Summary
		References
Part VI: Onco-Critical Care
	32: Onco-Critical Care
		32.1	 Introduction
		32.2	 Patient Admission into Oncology Critical Care
			32.2.1	 Trends in Onco-Critical Care
			32.2.2	 Challenges in Onco-Critical Care
		32.3	 Critical Care Issues in Oncology
			32.3.1	 Tumor Lysis Syndrome (TLS)
			32.3.2	 Hypercalcemia
			32.3.3	 Hyponatremia
			32.3.4	 Acute Respiratory Failure
			32.3.5	 Management of Acute respiratory distress syndrome (ARDS) in ICU
				32.3.5.1	 Role of Noninvasive Ventilation (NIV) in ARDS Management
				32.3.5.2	 Role of High-Flow Oxygen Therapy in ARDS Management
			32.3.6	 Sepsis
			32.3.7	 Airway Emergencies
			32.3.8	 Acute Abdomen
			32.3.9	 Cardiac Failure and Cardiac Tamponade
			32.3.10	 Central Nervous System (CNS) Emergencies
			32.3.11	 Adrenal Crisis or Adrenal Insufficiency
		32.4	 Postoperative Care in Oncology
		32.5	 Transfusion Practices in Onco-Critical Care
		32.6	 Chemotherapy in ICU
		32.7	 Infection Control in ICU
		32.8	 Nutrition in Onco-Critical Care
		32.9	 ICU Outcomes of Cancer Patients
		32.10	 Palliative Care in ICU
		32.11	 End-of-Life Care (EOLC) in ICU
		32.12	 Integrated Intensive Care Management of Onco-Critical Care
		32.13	 Summary
		References
Part VII: Allied Onco-Specialties
	33: Palliative and End-of-Life Care for Advanced Cancer
		33.1	 Introduction
		33.2	 Palliative Care in Advanced Cancer
		33.3	 Palliative Care and ICU
		33.4	 Palliative Onco-Surgery
		33.5	 End-of-Life Care (EOLC)
		33.6	 Initiatives to Enhance EOLC
		33.7	 Summary
		References
Part VIII: Miscellaneous
	34: Perioperative Complications in Oncosurgeries
		34.1	 Introduction
		34.2	 Perioperative Complications in Oncosurgeries
		34.3	 General Perioperative Complications in Oncosurgeries
			34.3.1	 Inadvertent Perioperative Hypothermia (IPH)
			34.3.2	 Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)
			34.3.3	 Perioperative Injuries
			34.3.4	 Postoperative Pulmonary Complications (PPC)
			34.3.5	 Perioperative Sepsis
			34.3.6	 Postoperative Nausea and Vomiting
			34.3.7	 Postoperative Atrial Fibrillation (POAF)
			34.3.8	 Chronic Postsurgical Pain (CPSP)
		34.4	 Specific Perioperative Complications in Oncosurgeries
			34.4.1	 Chemotherapy- and Radiotherapy-Related Perioperative Complications
			34.4.2	 Challenges of Chronic Opioid Therapy
			34.4.3	 Malnutrition, Hypoalbuminemia, and Anemia
			34.4.4	 Difficult Airway
			34.4.5	 Problems of Brachytherapy and Intraoperative Radiation
			34.4.6	 Carotid Blow Out Syndrome
			34.4.7	 Microvascular Flap Necrosis
			34.4.8	 Chyle Leak and Its Management
		34.5	 Summary
		References
	35: Anesthesia for Operative Oncological Emergencies
		35.1	 Introduction
		35.2	 General Considerations
		35.3	 Malignant Bowel Obstruction
			35.3.1	 Preoperative Optimization
			35.3.2	 Anesthetic Management
			35.3.3	 Postoperative Period
		35.4	 Bowel Perforation
		35.5	 Malignant Spinal Cord Compression
			35.5.1	 Preoperative Evaluation
			35.5.2	 Intraoperative Management
			35.5.3	 Postoperative Management
		35.6	 Surgery for Brain Metastases
		35.7	 Tumor Bleeding
		35.8	 Summary
		References
	36: Enhanced Surgical Recovery and Cancer
		36.1	 Introduction
		36.2	 Preoperative Preparation
			36.2.1	 Advanced Care Planning
			36.2.2	 Education
			36.2.3	 Nutritional Concerns
				36.2.3.1	 Prehabilitation
		36.3	 Intraoperative Management
			36.3.1	 Postoperative Nausea and Vomiting (PONV) Prophylaxis
			36.3.2	 Fluid Management
			36.3.3	 Multimodal Pain Management
		36.4	 Postoperative Care
			36.4.1	 Pain Management Maintenance
			36.4.2	 Postsurgical Complications and Return to Intended Oncological Therapies (RIOT)
			36.4.3	 Health-Related Quality-of-Life Assessment
		36.5	 Summary
		References
	37: Anesthesia for Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
		37.1	 Introduction
		37.2	 Patient Selection/Indications
			37.2.1	 Methods of HIPEC
			37.2.2	 Mechanism of Action of HIPEC
			37.2.3	 Concerns for CRS and HIPEC
				37.2.3.1	 Cardiovascular Changes
				37.2.3.2	 Respiratory Changes
				37.2.3.3	 Renal Changes
				37.2.3.4	 Coagulation Alterations
				37.2.3.5	 Metabolic Perturbations
				37.2.3.6	 Nutrition
			37.2.4	 Preoperative Assessment
				37.2.4.1	 Cardiovascular System
				37.2.4.2	 Respiratory System
				37.2.4.3	 Renal
				37.2.4.4	 Coagulation Status
				37.2.4.5	 Nutrition Status
			37.2.5	 Preoperative Optimization
				37.2.5.1	 Cardiovascular System
				37.2.5.2	 Respiratory System
				37.2.5.3	 Renal System
				37.2.5.4	 Nutrition
				37.2.5.5	 Prehabilitation
		37.3	 Temperature Regulation
			37.3.1	 Perioperative Pain Management
		37.4	 Drugs for HIPEC
			37.4.1	 HIPEC: Carrier Solution
			37.4.2	 Intraoperative Period
				37.4.2.1	 Intraoperative Monitoring
				37.4.2.2	 Airway and Ventilatory Management
				37.4.2.3	 Hemodynamic Management
				37.4.2.4	 Fluid and Blood Management
				37.4.2.5	 Renal System and Electrolyte Balance Management
				37.4.2.6	 Antiemetics
			37.4.3	 Postoperative Management
				37.4.3.1	 Anesthesiologists and Operating Room Safety Issues with HIPEC
		37.5	 Predictors/Markers of Perioperative Morbidity and Mortality
		37.6	 Other Hyperthermic Chemotherapy Surgical Procedures
			37.6.1	 Pressurized Intraperitoneal Aerosolized Chemotherapy (PIPAC)
			37.6.2	 Hyperthermic Intrathoracic Chemotherapy
		37.7	 Summary
		References
	38: Perioperative Anemia Management for  the Onco-Surgical Patient
		38.1	 Introduction
		38.2	 Erythropoiesis-Stimulating Agents and Iron
		38.3	 Blood Transfusions
		38.4	 Transfusion-Related Immunomodulation
		38.5	 Blood Transfusions and Its Impact on Prostate Cancer
		38.6	 Blood Products: Leukoreduction
		38.7	 Blood Products: Cytomegalovirus (CMV) Negative
		38.8	 Blood Products: Irradiated Blood Components
		38.9	 Intraoperative Blood Salvage
		38.10	 Preoperative Blood Conservation Strategies: Acute Normovolemic Hemodilution and Preoperative Autologous Blood Donation
		38.11	 Summary
		References