Mod11: Radiation Therapy - Cardiac Catheterization - AICD implantation

Question 1

_{Anesthesia for Radiology & Radiation Therapy}

When does anesthesia usually gets envolved in Radiation Therapy?

Answer 1

When Radiation Therapy is performed in children

Question 2

_{Anesthesia for Radiology & Radiation Therapy}

What is Radiation Therapy?

Answer 2

External beam radiation

Used in the Treatment of malignancies

Question 3

_{Anesthesia for Radiation Therapy}

Over what period of time does Radiation Therapy treament takes places?

Answer 3

Series of treatments over several weeks

First Tx last about 2 hrs

Subsequent Tx last about 30 min per Tx

Question 4

_{Anesthesia for Radiation Therapy}

Why must all personel leave the room during Tx?

Answer 4

V_ery high dose_ radiations are emitted

Pt cannot be directly observed during Tx

Must have all your monitors properly placed for remote viewing

In case of emergency, procede as with MRI

Stop radiation

Question 5

_{Anesthesia for Radiation Therapy}

Why are patients receiving External beam radiation at risk for sepsis, thrombocytopenia, anemia?

Answer 5

Chemo!!!

Many received cytotoxic and

immunosuppressant chemotherapy

before radition therapy

_{This is more relevant when providing surgical anesthesia care because of its effect in terms of infection and bleeding time}

Question 6

_{Anesthesia for Radiation Therapy}

What will you have to do if they move during therapy?

Answer 6

You will have to reorganize everything
​

Question 7

_{Anesthesia for Radiation Therapy}

Why should you focus on keeping the pt comfortable for short periods at the time?

Answer 7

Radition Therapy has Rapid onset

w/ Brief duration of action &

Rapid recovery

Question 8

_{Anesthesia for Radiation Therapy}

True or False: radiation therapy is painful to administer

Answer 8

False

Radiation therapy is Not painful to administer

It is stimulating and they must remain immobile

Keeping them immobile is your priotity

Question 9

_{Anesthesia for Radiation Therapy}

What’s the concern with airway maintenance during radiation therapy?

Answer 9

Variety of different body positions makes airway maintenance difficult

Question 10

_{Anesthesia for Radiation Therapy}

What are choices of Anesthetic Techniques with radition therapy?

Answer 10

General anesthesia

Deep sedation*

^{Goal is to prevent pt movement}

Question 11

_{Anesthesia for Radiation Therapy}

Intraoperative radiation to tumor masses is radiation therapy provided after surgical exposure in the OR. These masses could be of which types?

Answer 11

Pancreatic, colon, rectal, ovarian, cervical, breast

Question 12

_{Anesthesia for Radiation Therapy}

Which type of anesthesia is used for intraoperative radiation?

Answer 12

Usually requires General anesthetic

Regional may be feasible for cervical/rectal

Question 13

_{Anesthesia for Radiation Therapy}

Pts requiring intraoperative radiation may require transport back and forth from OR to radiation suite, what must be present to ensure pt’s safety throughout?

Answer 13

Portable monitors

Methods of O2 delivery

Agents to maintain general anesthesia/sedation

Question 14

_{Anesthesia for Radiation Therapy - Intraoperative radiation}

Pt’s requiring intraoperative radiation typically suffer from advanced cancer. What associated metabolic derrangements should you plan for?

Answer 14

Malnutrition

Electrolyte imbalances

Dehydration

Coagulopathies

Question 15

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

Which type of anesthesia do minimal diagnostic & Therapeutic Cardiac Catheterization procedures require?

Answer 15

Light sedation only

Question 16

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

Which more complex procedures requiring more invasive monitoring and general anesthesia are performed in Cardiac Catheterization?

Answer 16

Pediatric patients with CHD

^{(Less than 6 mo, requiring ETT, often pre major OHS)}

Removal AICDs

Endovascular stenting of thoracic/abdominal aortic aneurysms

Question 17

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

What’s the main purpose of Electrophysiologic Procedures?

Answer 17

Ablation of abnormal conduction pathways for treatment of dysrhythmias caused by aberrant conduction pathways

Question 18

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

Why do Electrophysiologic Procedures require sedation or general anesthesia (esp. children)?

Answer 18

Because they are Lengthy & painful!!!

Question 19

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

Why are Electrophysiologic Procedures lengthy?

Answer 19

Takes time to located the focus needing ablation

Pt’s response to ablation unknown

Question 20

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

Why are Electrophysiologic Procedures painful?

Answer 20

They are changing the rate and rhythm of the heart, while

Burning and freezing inside the chest itself

This why they require Deep sedation or GA

(esp. younger children)

Question 21

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

How is General anesthesia provided during Cardiac Catheterization?

Answer 21

Combination of volatiles and propofol

Not shown to interfere with cardiac conduction during these procedures

Could also use “Room Air General” + Propofol + Remi

^{(Oxygen via face mask)}

Question 22

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

What should you consider when deciding between a TIVA vs. volatile anesthetics in children?

Answer 22

GA is associated with high incidence of N/V children

Question 23

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

Which types of drugs should never be given in the EP lab?

Answer 23

Any drug that could change the Heart rhythm

No Lidocaine => will stabilize the heart => will prevent localization of dysrhythmias

No versed => versed will knock out dysrhythmias => EP wants to localize where they originate so they can be treated

No volatile agents alone => May give volatile agents mixed with propofol => volatile agents alone will knock out dysrhythmias

No Phenylephrine => will cause bardycardia

No Ephedrine => will cause tachycardia

Give Vasopressin for pressure support

Question 24

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

Why should Lidocaine Not be given in the EP lab?

Answer 24

It will stabilize the heart

This will prevent localization of dysrhythmias

Question 25

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

Why should Versed Not be given in the EP lab?

Answer 25

Versed will knock out dysrhythmias

EP wants to localize where they originate so they can be treated

Question 26

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

Why should volatile agentsNot be given alone in the EP lab?

Answer 26

Volatile agents alone will knock out dysrhythmias

May give volatile agents mixed with propofol

Question 27

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

Why should Phenylephrine Not be given in the EP lab?

Answer 27

It will cause bardycardia

Question 28

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

Why should Ephedrine Not be given in the EP lab?

Answer 28

It will cause tachycardia

Question 29

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

What is the appropriate pressor to use in the EP lab?

Answer 29

Vasopressin

Question 30

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

Why should you administer smaller doses of anesthetic agents in the EP lab and give it time to work?

Answer 30

Most patients have low EF, and

Longer circulatory time

Question 31

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

True or False: Pts who cannot lay flat or those undergoing RHC often require ETT

Answer 31

True

Question 32

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

Why are AICDs implated?

Answer 32

To reduced mortality in patients with

Ventricular Tachyarrhythmias and LVD due to MI

Question 33

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

In which clinical area are AICDs typically implated?

Answer 33

In the EP lab rather than operating room

(Not unusual to see them implanted in the OR)

Question 34

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

AICD implantation is not a painful procedure but which part of the procedure is distressing

Answer 34

Induction of VF to test device

Question 35

_{Anesthesia for Radiology & Radiation Therapy - Cardiac Catheterization}

Which anesthetic technique is appropriate for AICD implantation?

Answer 35

Deep sedation usually

^{(Versed/Fentanyl; Propofol/Remi; Propofol/Fentanyl boluses)}

Airway instrumentation is rare

General anesthesia possible