Anaesthetic implications of anticancer chemotherapy

Kvolik, Slavica; Glavaš‐Obrovac, Ljubica; Šakić, Kata; Margaretić, Damir; Karner, Ivan

doi:10.1017/s026502150300139x

Cited by 11 publications

(3 citation statements)

References 90 publications

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“…Anticancer chemotherapy is known to be cardiotoxic, 26 and it appears that chemotherapy increases the postoperative cardiac risk after head and neck cancer surgery. The most frequent cytotoxic agents used to treat head and neck cancers are cisplatin and 5-fluorouracil, which have nephrotoxic and cardiotoxic effects, respectively.…”

Section: Discussionmentioning

confidence: 99%

Postoperative myocardial injury after major head and neck cancer surgery

Nägele

Rao

Kallogjeri

et al. 2010

European Journal of Anaesthesiology

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Background. Patients with head and neck cancer often have multiple risk factors for coronary artery disease. Yet, little is known about the incidence of postoperative myocardial injury after major head and neck cancer surgery and its clinical relevance. The aim of this study was to determine the risk of postoperative myocardial injury in patients undergoing major head and neck cancer surgery.Methods. This was a retrospective cohort study of all patients who underwent major head and neck cancer surgery (n ¼ 378) at a single major academic center from April 2003 to July 2008. Peak postoperative troponin I (TnI) concentration was the primary outcome.Results. Of 378 patients who underwent major head and neck cancer surgery, 57 patients (15%) had development of an elevated TnI; 90% of these occurred within the first 24 hours after surgery. Preexisting renal insufficiency (unadjusted OR [OR]: 4.60; 95% CI 1.53-13.82), coronary artery disease (OR: 2.33; 95% CI 1.21-4.50), peripheral vascular disease (OR: 2.83; 95% CI 1.31-6.14), hypertension (OR: 2.22; 95% CI 1.20-4.12), and previous combined chemotherapy and radiation (OR: 2.68; 95% CI 1.04-6.91) were associated with elevated postoperative TnI levels. Patients with elevated TnI levels had a significantly longer length of stay in the hospital (8.5 vs 10.1 days; p ¼ .014) and ICU (3 vs 4.5 days; p ¼ .001) and an 8-fold increased risk of death at 60 days after surgery (adjusted OR: 8.01, 95% CI 2.03-31.56). At 1 year, patients with an abnormal postoperative TnI level were twice as likely to die (OR 1.93; 95% CI 1.02-3.63).Conclusions. Patients who undergo major head and neck cancer surgery are at significant risk for postoperative myocardial injury, which is a strong predictor of 60-day mortality after surgery. Monitoring of myocardial injury during the first postoperative days, as well as optimizing preventive cardiac care, may be helpful to reduce postoperative mortality rates. Head Neck 33: 1085-1091, 2011Keywords: Myocardial infarction; Outcomes; Troponin Worldwide more than half a million new cases of head and neck cancer are diagnosed each year.1 Head and neck cancer is commonly caused by long-term tobacco and alcohol abuse.2 Long-term smoking and tobacco abuse increases the risk for not only cancer but also coronary artery disease and myocardial infarction. Most patients present with advanced-stage cancer, and many will undergo treatment with surgery either as the initial therapy or as salvage surgery after previously failed radiotherapy or chemoradiotherapy.Surgery for head and neck cancer is complex and extensive because it commonly involves the resection of the tumor and unilateral or bilateral radical neck dissection and often requires transfer of a tissue flap for reconstruction.1 Major head and neck cancer surgery frequently lasts more than 8 hours, involves large fluid shifts and blood loss, and causes significant postoperative inflammation and pain. All these factors are considered important risk factors for postoperative myocardial injury.Postope...

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Section: Discussionmentioning

confidence: 99%

Postoperative myocardial injury after major head and neck cancer surgery

Nägele

Rao

Kallogjeri

et al. 2010

European Journal of Anaesthesiology

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show abstract

“…Anticancer chemotherapy is known to be cardiotoxic,26 and it appears that chemotherapy increases the postoperative cardiac risk after head and neck cancer surgery. The most frequent cytotoxic agents used to treat head and neck cancers are cisplatin and 5‐fluorouracil, which have nephrotoxic and cardiotoxic effects, respectively 27, 28.…”

Section: Discussionmentioning

confidence: 99%

Postoperative myocardial injury after major head and neck cancer surgery

et al. 2010

View full text Add to dashboard Cite

Background Head and neck cancer patients often have multiple risk factors for coronary artery disease. Yet, little is known about the incidence of postoperative myocardial injury after major head and neck cancer surgery and its clinical relevance. The aim of the study was to determine the risk of postoperative myocardial injury in patients undergoing major head and neck cancer surgery. Methods Retrospective cohort study of all patients who underwent major head and neck cancer surgery (n=378) at a single major academic center from April 2003 to July 2008. Peak postoperative troponin I (TnI) concentration was the primary outcome. Results Of 378 patients, who underwent major head and neck cancer surgery, 57 patients (15%) developed an elevated TnI; 90% of which occurred within the first 24 hours after surgery. Pre-existing renal insufficiency (unadjusted OR [OR]: 4.60, 95% CI 1.53–13.82), coronary artery disease (OR: 2.33, 95% CI 1.21–4.50), peripheral vascular disease (OR: 2.83, 95%CI 1.31–6.14), hypertension (OR: 2.22, 95% CI 1.20–4.12), and previous combined chemotherapy and radiation (OR: 2.68, 95% CI 1.04–6.91) were associated with elevated postoperative TnI. Patients with elevated TnI had a significantly longer length of stay in the hospital (8.5 vs. 10.1 days; p= 0.014) and ICU (3 vs. 4.5 days; p= 0.001) and an 8-fold increased risk of death at 60 days after surgery (adjusted OR: 8.01, 95% CI 2.03 – 31.56). At one year, patients with an abnormal postoperative TnI were twice as likely to die (OR 1.93; 95% CI 1.02 – 3.63). Conclusions Patients who undergo major head and neck cancer surgery are at significant risk for postoperative myocardial injury which is a strong predictor of 60-day mortality after surgery. Monitoring of myocardial injury during the first postoperative days as well as optimizing preventive cardiac care may be helpful to reduce postoperative mortality.

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“…Children with the following histories represent an increased likelihood of hematologic abnormalities. Patients at risk of anemia include those with a new diagnosis of leukemia (50–80% incidence) or lymphoma (46–48), recent chemotherapy or irradiation, recent stem cell transplant, recent bleeding (49–51), or <6 months of age (52). The risk of hyperleukocytosis exists in patients with an acute leukemia (>20% incidence) (46,47), and the risk of leukopenia and neutropenia is significant in any child receiving aggressive chemotherapy or irradiation (45).…”

Section: Preoperative Testing and Evaluationmentioning

confidence: 99%

Anesthetic considerations for the pediatric oncology patient - Part 3: pain, cognitive dysfunction, and preoperative evaluation

Latham

Greenberg

2010

Pediatric Anesthesia

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In part three of this three-part review, we continue with discussion of the effects of tumor and its therapy as they impact neurocognitive functioning, psychosocial issues of the patient and family, and the mechanisms and experience of pain in the child with cancer. A discussion of preanesthetic testing and evaluation in this patient population is next presented for the reader, focusing on the factors which pose the commonest and greatest risks to the child undergoing surgery. Lastly, an algorithmic approach to evaluating and managing key components of the medical history of pediatric patients is presented.

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Anaesthetic implications of anticancer chemotherapy

Cited by 11 publications

References 90 publications

Postoperative myocardial injury after major head and neck cancer surgery

Postoperative myocardial injury after major head and neck cancer surgery

Postoperative myocardial injury after major head and neck cancer surgery

Anesthetic considerations for the pediatric oncology patient - Part 3: pain, cognitive dysfunction, and preoperative evaluation

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