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Anaesthetic implications of anticancer chemotherapy

Published online by Cambridge University Press:  11 July 2005

S. Kvolik ,
L. Glavas-Obrovac ,
K. Sakic ,
D. Margaretic  and
I. Karner
S. Kvolik
Affiliation:
University Clinical Hospital Osijek, Department of Anaesthesiology and ICU, Osijek, Croatia
L. Glavas-Obrovac
Affiliation:
University of Zagreb, Clinical Hospital Dubrava, Department of Oncology and Radiotherapy, Zagreb, Croatia
K. Sakic
Affiliation:
University of Zagreb, Clinical Hospital Dubrava, Department of Anaesthesiology and ICU, Zagreb, Croatia
D. Margaretic
Affiliation:
University of Zagreb, Clinical Hospital Dubrava, Department of Nuclear Medicine and Pathophysiology, Zagreb, Croatia
I. Karner
Affiliation:
University of Zagreb, Clinical Hospital Dubrava, Department of Oncology and Radiotherapy, Zagreb, Croatia
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Abstract

Summary

In anaesthetic practice we deal with cancer patients who are scheduled for operations on tumours or other manifestations of malignant disease. Those patients are often debilitated and have significant weight loss accompanied with hypoproteinaemia, anaemia and coagulation disorders. Oncological patients usually present to the anaesthetist before tumour disease surgery, but they are also candidates for elective operations (e.g. hernia repair) and urgent/emergency surgery (e.g. trauma, fractures and ileus). Chemotherapeutic agents given to these patients are potentially noxious, can affect the conduct of anaesthesia and, furthermore, may aggravate the patient's condition.

In this review the most commonly used cytostatic drug regimens and their common side-effects are listed. Some preclinical studies on anaesthetic and cytostatic drug metabolism and interactions are emphasized, as well as clinically relevant perioperative alterations that may affect anaesthetic management in cancer patients.

An anaesthetist may have to modify a routine anaesthetic regimen in cancer patients especially if anticancer chemotherapeutics were given. Clinically silent toxic drug effects may become apparent during operation, trauma or in the early postoperative course in such patients. Altered reactions to commonly used anaesthetics in patients receiving chemotherapeutics and an impaired stress reaction may occur in such patients. Special attention must be drawn to protection against opportunistic infections.

Keywords

ANAESTHETICS, GENERALANTINEOPLASTIC AGENTSANTINEOPLASTIC COMBINED CHEMOTHERAPY PROTOCOLSCOMBINED MODALITY THERAPY, chemotherapy, adjuvant, neoadjuvant therapyDRUG INTERACTIONS, drug antagonism, drug synergismRADIOTHERAPY, adjuvant
Type
Review
Information
European Journal of Anaesthesiology , Volume 20 , Issue 11 , November 2003 , pp. 859 - 871
Copyright
2003 European Society of Anaesthesiology

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