Anesthesia Challenges in Interventional Oncology
Better technology and imaging has allowed image-guided cancer therapy once only performed in the traditional operating room to be performed as minimally invasive procedures in other locales. The complexity of the procedures, the level of sedation required
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Anesthesia Challenges in Interventional Oncology Mary Fischer and Alan Kotin
Abstract
Better technology and imaging has allowed image-guided cancer therapy once only performed in the traditional operating room to be performed as minimally invasive procedures in other locales. The complexity of the procedures, the level of sedation required, and the comorbidities of the patients have created a need for the anesthesia care provider’s presence. This chapter discusses the role and challenges of the anesthesiologist in interventional oncology for procedures outside the traditional operating room. Technological advancement and movement toward closed body, minimally invasive surgery has moved interventional oncology procedures, once only performed in the operating room (OR), to nontraditional locales. Historically, patient sedation in the interventional operating room has been performed under the supervision of the interventional physician. Complex procedures and the Joint Commission on Accreditation of Healthcare Organization (JCAHO) regulations led to the anesthesiology and interventional physicians working more closely together [1]. Despite the apparent simplicity of this new relationship, working outside the main operating room can be very complex. In order for the anesthesiologist to guarantee the same level of safety for the patient, the anesthesiologist must be familiar with the procedure, the location, and the potential complications. The interventionalist must be familiar with the practice guidelines and standard of anesthesia care. This chapter provides the extensive list of issues that must be addressed before the anesthesia image-guided oncology team begins patient care as well as the unique anesthetic considerations of patients undergoing image-guided cancer therapy.
M. Fischer (*) A. Kotin Department of Anesthesia and Critical Care, Memorial Sloan-Kettering Cancer Center, New York, NY, USA e-mail: [email protected]; [email protected] D.E. Dupuy et al. (eds.), Image-Guided Cancer Therapy, DOI 10.1007/978-1-4419-0751-6_11, # Springer Science+Business Media New York 2013
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Practice Guidelines The American Society of Anesthesiology (ASA) has long been an advocate for patient safety. Although anesthesiologists may not be directly involved in the care of all patients receiving sedation/analgesia for a procedure, there is a high likelihood that they are involved in creating, revising, and organizing sedation services in all hospitals. JCAHO, the American Pediatric Guidelines, and the American College of Radiology (ACR) contain recommendations made by the ASA for the safe administration and monitoring of sedation/analgesia outside the operating room [2]. The key components of these guidelines and regulations are defining the continuum for sedation/anesthesia and the qualifications for those administering sedation/analgesia. Because sedation is a continuum, it is not always possible to predict how an individual patient will respond; therefore, the practitioner administering sedation must be qualified t
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