May 2012
Nathan Waxer, DO
Anaesthetic Implications of Chemotherapy
Neil Allan MBChB FRCA EDIC; Catherine Siller MRCP PhD;
Andrew Breen MBChB FRCA 05/14/2012; Cont Edu Anaesth Crit Care &
Pain. 2012;12(2):52-56. © 2012 Oxford University Press
Many surgical patients that will go under the knife and
require anesthesia have had prior chemotherapy.
The reason why this is important to consider is that chemotherapy can be
very toxic to the natural cells of the body.
Common toxicities include cardiac, pulmonary, renal, hepatic, GI, bone
marrow, and neurological damage and should all be considered within the
anesthetic plan.
A few high yield examples from the article include:
Vincristine can cause neuropathy and seizures.
Cisplatin, carboplatin, and oxaliplatin, are a common cause of renal
tubular and glomerular damage.
Cyclophosphamide causes direct endothelial damage and haemorrhagic
pericarditis or myocarditis. In particular
bleomycin toxicity can cause pulmonary fibrosis, and is important to avoid high
inspired FiO2 on patients with bleomycin and if possible in those whom
chemotherapy has been used but the agents are unknown.
CBC, blood biochemistry, ECG, are mandatory, and chest
X-ray, an arterial blood gas, pulmonary function tests, and an echocardiogram,
are tests that should be considered and may be required depending upon the
treatment regimen used.
Overall this is an informative and valuable review for the
anesthesia provider of the commonly used chemotherapy agents and the
physiological effects that they can cause.
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