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ONCOANESTHESIA: An
emerging sub-speciality
DR. ABHIJIT S. NAIR
Consultant Anesthesiologist
BIACH & RI, Hyderabad
 Anesthesiology: complex speciality
 Anesthesiologist: JACK OF ALL
 Several subfields/ sub-specialities
Anesthesiology
 Cardiothoracic ( Adult/ Pediatric )
 Neuro-anesthesia
 Obstetric
 Pediatric
 Geriatric
 Regional
 Intensive Care
 Chronic Pain
cont
 Orthopedic
 Transplant ( Liver )
 Ophthalmic
 Bariatric
 Ambulatory
 Trauma
 Palliative care
 ONCOANESTHESIA
Around 16 sub-specialties
Sub-specialities involved in
Oncoanesthesia
 Cardio-thoracic
 Neuro-anesthesia
 Obstetric
 Pediatric
 Geriatric
 Regional
 Intensive Care
 Chronic Pain
 Orthopedic
 Transplant ( Liver )
 Ophthalmic
 Bariatric
 Ambulatory
 Trauma
 Palliative care
Cancer patient
Needs special consideration
Stigma ( pain, suffering, IT’S OVER )
Lack of awareness
Isolate themselves socially/ self-imprisonment
Anxiety/ lack of interest
Absenteeism ( work, school)
Social support ( family, colleagues, friends )
Cont.
 Chemotherapy
 Radiation
 Immunity affected
 Malnourished
 Hemostatic changes
 PONV
Anesthesiologist in cancer
hospital
 Involved in patient care in several stages
Diagnostic
Facilitates treatment
Peri-operative
Pain clinic
Medical emergency
Palliative care
Radiotherapy
BMT
I/T injections
Why?
 High risk patients ( elderly, co-morbidities )
 Sick patients
 Supra major surgeries ( Oesophagectomy,
thoracotomy, laparotomy, mega-prosthesis )
 Major blood loss, massive transfusion
 Post chemotherapy status
 Post radiation status
 Pain management ( acute/ chronic )
50-70 % patients experience pain
which is sub-optimally treated
DIFFICULT AIRWAY
C-MAC
FOB
One lung ventilation
 Regional anesthesia
 Nutritional issues peri-operatively
 Electrolyte imbalance
 Post-chemotherapy status
Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP.Toxicity and
response criteria of the Eastern Cooperative Oncology Group.Am J Clin Oncol. 1982 Dec;5(6):649-55.
Eastern Cooperative Oncology Group
Subjective Global Assessment
 A: Well nourished
 B: Moderately malnourished ( suspected )
 C: Severely malnourished
HISTORY PHYSICAL EXAMINATION
1.Weight change
2.Dietary intake change
3.GI symptoms > 2 wks
4.Functional capacity
5.Related to disease
1.Loss of fat
2.Muscle wasting
3.Oedema
4.Ascites
Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition
assessment tool in patients with cancer.Eur J Clin Nutr. 2002 Aug;56(8):779-85.
 Critical care issues
 Vascular access
 USG ( lines, blocks, airway, Neuraxial)
Learning opportunities:
 Airway skills ( gadgets, FOB, Em.
tracheostomy, airway USG )
 USG ( regional anesthesia, ICU )
 Hemodynamic monitoring
 ICDs
 Peri-operative nutrition
Advanced vascular access ( Chemoport,
Hickman, PICC: Groshong, Broviac)
Intensive care
 Rationale use of vasopressor
 Ventilation strategies ( invasive/ non-
invasive )
 Difficult weaning
 Percutaneous tracheostomy
FATE/ FAST applications
ct
 Evidence based antibiotic use
 Resuscitation
 Palliative care
 Communication skills
 Documentation
Other advantages:
 Single specialty centers
 High volume centre
 Teaching hospital
 Research
 Retrospective data
 RCTs, case series
 COHORT’s
Fellowships :
 TMH, Mumbai
 TMH, Calcutta
 HCG Cancer Centre, Ahmedabad
 Max Hospitals, New Delhi
DM Oncoanesthesia
 Dr. Bhimrao Ambedkar Institute-Rotary Cancer
Hospital, under the aegis of AIIMS, New Delhi
Onco-centres In India:
 TMH ( Mumbai, Kolkata )
 Adyar CI
 Kidwai Memorial Institute of Oncology
 GCRI
 MGCH & RI, Vizag
 RGCI & RC, Indraprashtha
 Chittaranjan National CI, Kolkata
 Dharamshila Hospital, Delhi NCR
etc
In Hyderabad
 BIACH & RI
 MNJ
 AOI/ Citizens Hospital
 Apollo
 Yashoda Hospitals
 Care Hospitals, Gachibowli !!
SCOPE
 Cancer hospitals on the rise
 Cancer incidence more
 Separate cancer blocks in several
corporate hospitals
 Anesthesiologists trained in
oncoanesthesia: an asset
 Can manage OT, SICU, Oncology medical ICU
 Pain clinics
 Perioperative physicians
 Team leaders, educators
 Trained in procedures :
Vascular access ( routine and advanced ), IT
injections, PCDT
Conclusion
 Anesthesiologists working in oncology
centers are exposed to all aspects and almost
all sub-specialties of Anesthesiology
 Onco-anesthesia is not a sub-speciality; it’s a
super-speciality
Onconesthesia : An emerging subspeciality
Onconesthesia : An emerging subspeciality

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Onconesthesia : An emerging subspeciality

  • 1. ONCOANESTHESIA: An emerging sub-speciality DR. ABHIJIT S. NAIR Consultant Anesthesiologist BIACH & RI, Hyderabad
  • 2.
  • 3.  Anesthesiology: complex speciality  Anesthesiologist: JACK OF ALL  Several subfields/ sub-specialities
  • 4.
  • 5. Anesthesiology  Cardiothoracic ( Adult/ Pediatric )  Neuro-anesthesia  Obstetric  Pediatric  Geriatric  Regional  Intensive Care  Chronic Pain cont
  • 6.  Orthopedic  Transplant ( Liver )  Ophthalmic  Bariatric  Ambulatory  Trauma  Palliative care  ONCOANESTHESIA
  • 8. Sub-specialities involved in Oncoanesthesia  Cardio-thoracic  Neuro-anesthesia  Obstetric  Pediatric  Geriatric  Regional  Intensive Care  Chronic Pain  Orthopedic  Transplant ( Liver )  Ophthalmic  Bariatric  Ambulatory  Trauma  Palliative care
  • 9.
  • 10. Cancer patient Needs special consideration Stigma ( pain, suffering, IT’S OVER ) Lack of awareness Isolate themselves socially/ self-imprisonment Anxiety/ lack of interest Absenteeism ( work, school) Social support ( family, colleagues, friends )
  • 11. Cont.  Chemotherapy  Radiation  Immunity affected  Malnourished  Hemostatic changes  PONV
  • 12. Anesthesiologist in cancer hospital  Involved in patient care in several stages Diagnostic Facilitates treatment Peri-operative Pain clinic Medical emergency Palliative care Radiotherapy BMT I/T injections
  • 13. Why?  High risk patients ( elderly, co-morbidities )  Sick patients  Supra major surgeries ( Oesophagectomy, thoracotomy, laparotomy, mega-prosthesis )  Major blood loss, massive transfusion  Post chemotherapy status  Post radiation status
  • 14.  Pain management ( acute/ chronic ) 50-70 % patients experience pain which is sub-optimally treated
  • 16. C-MAC
  • 17. FOB
  • 20.
  • 21.  Nutritional issues peri-operatively  Electrolyte imbalance  Post-chemotherapy status Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP.Toxicity and response criteria of the Eastern Cooperative Oncology Group.Am J Clin Oncol. 1982 Dec;5(6):649-55. Eastern Cooperative Oncology Group
  • 22. Subjective Global Assessment  A: Well nourished  B: Moderately malnourished ( suspected )  C: Severely malnourished HISTORY PHYSICAL EXAMINATION 1.Weight change 2.Dietary intake change 3.GI symptoms > 2 wks 4.Functional capacity 5.Related to disease 1.Loss of fat 2.Muscle wasting 3.Oedema 4.Ascites Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer.Eur J Clin Nutr. 2002 Aug;56(8):779-85.
  • 23.
  • 24.  Critical care issues  Vascular access  USG ( lines, blocks, airway, Neuraxial)
  • 25. Learning opportunities:  Airway skills ( gadgets, FOB, Em. tracheostomy, airway USG )  USG ( regional anesthesia, ICU )  Hemodynamic monitoring  ICDs  Peri-operative nutrition
  • 26. Advanced vascular access ( Chemoport, Hickman, PICC: Groshong, Broviac)
  • 27.
  • 29.  Rationale use of vasopressor  Ventilation strategies ( invasive/ non- invasive )  Difficult weaning  Percutaneous tracheostomy
  • 31. ct  Evidence based antibiotic use  Resuscitation  Palliative care  Communication skills  Documentation
  • 32. Other advantages:  Single specialty centers  High volume centre  Teaching hospital  Research  Retrospective data  RCTs, case series  COHORT’s
  • 33. Fellowships :  TMH, Mumbai  TMH, Calcutta  HCG Cancer Centre, Ahmedabad  Max Hospitals, New Delhi
  • 34. DM Oncoanesthesia  Dr. Bhimrao Ambedkar Institute-Rotary Cancer Hospital, under the aegis of AIIMS, New Delhi
  • 35. Onco-centres In India:  TMH ( Mumbai, Kolkata )  Adyar CI  Kidwai Memorial Institute of Oncology  GCRI  MGCH & RI, Vizag  RGCI & RC, Indraprashtha  Chittaranjan National CI, Kolkata  Dharamshila Hospital, Delhi NCR etc
  • 36. In Hyderabad  BIACH & RI  MNJ  AOI/ Citizens Hospital  Apollo  Yashoda Hospitals  Care Hospitals, Gachibowli !!
  • 37. SCOPE  Cancer hospitals on the rise  Cancer incidence more  Separate cancer blocks in several corporate hospitals  Anesthesiologists trained in oncoanesthesia: an asset
  • 38.  Can manage OT, SICU, Oncology medical ICU  Pain clinics  Perioperative physicians  Team leaders, educators  Trained in procedures : Vascular access ( routine and advanced ), IT injections, PCDT
  • 39. Conclusion  Anesthesiologists working in oncology centers are exposed to all aspects and almost all sub-specialties of Anesthesiology  Onco-anesthesia is not a sub-speciality; it’s a super-speciality

Editor's Notes

  1. Involves all basic medical sciences, medical & surgical sub/super specialities.
  2. ECOG: Eastern Cooperative Oncology Group
  3. FAST: Focused assessment with sonography in trauma, FATE: Focused assessment with trans-thoracic echo