Anesthetic management of simultaneous surgery for cancer and severe coronary artery disease: experience of 8 operations
Abstract Malignant tumors and ischemic heart disease (IHD) still remain the most common causes of death. Strategic approaches to the treatment of coronary heart disease is constantly updated and improved, but the majority of authors are in agreement on one thing: intensive treatment of unstable coronary syndromes should precede an elective non-cardiac surgery. Unfortunately, most modern technologies of interventional correction of coronary blood flow are often inapplicable for cancer patients.
Aim – to combine surgical treatment of heart disease and cancer.
Material and methods. The experience of 8 simultaneous operations for malignant tumors of various localization and concomitant severe coronary artery disease carried out in RAMS Cancer Research Center in 2006–2011.
Study design: prospective, level of evidence – III, which follows from a small number of observations in a very severe group of patients.
Results. The duration of anesthesia in patients was 8–10 hours; operative time – 6–8 hours. As can be seen from the data, all operations were very long and traumatic. As a method of anesthesia was chosen multimodal combined anesthesia (MMСA), modified according to the pre-, in-, or post-bypass period. MMCA allows for adequate analgesia even the most traumatic phases of the operation with minimal hemodynamic depression, while maintaining good handling and cardiovascular stability. The duration of postoperative hospital stay in 4 patients with a complicated course was 19–44 days, and in 4 patients with no complications – 12–15 days. All patients recovered and were discharged home. Cancer surgery in 7 patients were carried out with the greatest possible radicalism.
Conclusion. As can be seen from the data, we used a technique of anesthesia and post-operative intensive care possible to avoid pronounced hemodynamic instability. It is possible to ensure the tolerance of long and traumatic interventions, such as simultaneous operations in cancer patients with concomitant severe coronary artery disease.
Keywords:malignant tumors, coronary heart disease, simultaneous operations, multimodal combined anesthesia
Clin. Experiment. Surg. Petrovsky J. 2015. № 4. Р. 85–90.
References
1. G. Edward Morgan Jr., Maged S. Mikhail Clinical Anesthesiology. 2nd edition. St. Petersburg: Nevsky Dialect, 2000. Vol. 2: 34–76. (in Russian)
2. Pollard B.J. Manual of Clinical Anesthesiology. Moscow: MED press-inform, 2006: 160–9. (in Russian)
3. West J.N.W., Gammage M.D. Angina: strategies for management. 1993; Vol. 4: 124–34.
4. Poldermans D. et al. Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. Eur J Anaesthesiol. 2010; Vol. 27: 92–137.
5. Mangano D.T et al. Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group. N Engl J Med. 1990; Vol. 323: 1781–88.
6. Davydov M.I., Portnenko V.V., Gorobets E.S., Mazurin V.S. Simultaneous surgical treatment of mitral heart disease and lung cancer. Grudnaya i serdechno-sosudistaya khirurgiya [Thoracic and Cardiovascular Surgery]. 1994; Vol. 2: 76. (in Russian)
7. GorobetsE.S.,GruzdevV.E.,ZotovA.V.,TipisevD.A.,ShinA.R.Multimodal combined anesthesia for traumatic operations. Voprosy anesteziologii [Questions of Anesthesiology]. 2009; Vol. 3: 45–50. (in Russian)
8. De Hert S.G. et. al. Cardioprotection with volatile anaesthetics: mechanisms and clinical implications. Anesth Analg. 2005; Vol. 100: 1584–93.