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Pilar Martnez Becada anestesia USACH

15% nios 2 causa de muerte 1-14 a 1/3 leucemia 0-14 a

78% Leucemia linfoblastica aguda

1. Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient part 1: a review of antitumor Therapy anesthesia. Pediatr Anesth 2010; 20:295-304 2. Siegel R, Naishadham D, Jemal A. Cancer statistics 2012. CA Cancer J Clin 2012; 62:1029

Incidencia creciente anual: 0,5% Disminucin mortalidad: 4,9 por 100 000 (1975) 2,2 por 100 000 (2008) Sobrevida global a 5 aos: 83%

Siegel R, Naishadham D, Jemal A. Cancer statistics 2012. CA Cancer J Clin 2012; 62:1029

Mltiples cirugas Quimio-radioterapia Etapa terminal Efectos tumorales, tto Dolor Vulnerabilidad psicolgica

Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient part 1: a review of antitumor Therapy anesthesia. Pediatr Anesth 2010; 20:295-304

Mltiples frmacos Efectos adversos

Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient part 1: a review of antitumor Therapy anesthesia. Pediatr Anesth 2010; 20:295-304

Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient part 1: a review of antitumor Therapy anesthesia. Pediatr Anesth 2010; 20:295-304

Rituximab, cetuximab. Efecto sistmico: protena tumoral Descrito:


Rash Fatiga Nauseas, vmitos Diarrea Hipotensin

Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient part 1: a review of antitumor Therapy anesthesia. Pediatr Anesth 2010; 20:295-304

Tu intracardiacos: infrecuente

Rabdomiomas Fibromas

Compromiso CV

Hipotensin Arritmias No VA

Linfoma derrame pericardico


Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient part 2: systems-based approach to anesthesia. Pediatr Anesth 2010; 20:396-420

Antraciclinas

Doxorubicina y daunorubicina Otros: ciclofosfamida, cisplatino Cardiotxicas


Radicales libres Fn mitocondrial, inhibicin topoisomerasa II Aguda Reversible Crnica 65% cardiomiopata subclnica

1. Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient part 2: systems-based approach to anesthesia. Pediatr Anesth 2010; 20:396-420 2. Sahai S, Zalpour A. Preoperative Evaluation of the Oncology Patient. Med Clin N Am 2010; 403419

Antraciclinas + radiacin (>25-30 Gy)


Pericarditis Derrame pericardio Cardiomiopata Fibrosis endocardca Fibrosis valvular Alteraciones en la conduccin

1. Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient part 2: systems-based approach to anesthesia. Pediatr Anesth 2010; 20:396-420 2. Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient part 1: a review of antitumor Therapy anesthesia. Pediatr Anesth 2010; 20:295-304

Metstasis: Tu de Wilms, osteosarcoma Complicaciones respiratorias

Fibrosis pulmonar: asintomtica Bleomicina: 3-5% neumonitis


Busulfan, carmustine y mitomicina C

Irradiacin: neumonitis FiO2 baja

1. Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient part 2: systems-based approach to anesthesia. Pediatr Anesth 2010; 20:396-420 2. Sahai S, Zalpour A. Preoperative Evaluation of the Oncology Patient. Med Clin N Am 2010; 403419

Compresin VA

Infiltrado leucmico:
Adenoides Amgdalas

Adenopatas cervicales
SAOS

Evans P, Chisholm D. Anaesthesia and paediatric oncology. Curr Anaesth Crit Care 2008; 19: 5058

Tu de Wilms IRA: tto Cisplatino: 28-36%

Carboplatino e ifosfamida

Irradiacin

< 18 Gy

Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient part 2: systems-based approach to anesthesia. Pediatr Anesth 2010; 20:396-420

1% Tu nios 2/3 Tu malignos

Metrotrexato, 6-mercaptopurina, L-asparginasa


Coagulopata Disfn biliar Malnutricin

Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient part 2: systems-based approach to anesthesia. Pediatr Anesth 2010; 20:396-420

Nauseas y vmitos

Diarrea
Melfalan, 5-fluorouracilo Mucositis Enterocolitis neutropnica

Anestesia:

Retardo vaciamiento gstrico Aspiracin

1. Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient part 2: systems-based approach to anesthesia. Pediatr Anesth 2010; 20:396-420 2. Sahai S, Zalpour A. Preoperative Evaluation of the Oncology Patient. Med Clin N Am 2010; 403419

Mielosupresin

Anemia Leucopenia
Neutropenia: < 1500 cel/microL < 500 cel/microL Fiebre: 38,3C 38C x > 1 hr 7-10 das < 25% 10-40% infeccin

1. Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient part 2: systemsbased approach to anesthesia. Pediatr Anesth 2010; 20:396-420 2. Lalami Y, Paesmans M, Muanza F, et cols.Can we predict the duration of chemotherapy-induced neutropenia in febrile neutropenic patients, focusing on regimen-specific risk factors? A retrospective analysis. Annals of Oncology 2006;17: 507514

Lalami Y, Paesmans M, Muanza F, et cols.Can we predict the duration of chemotherapy-induced neutropenia in febrile neutropenic patients, focusing on regimen-specific risk factors? A retrospective analysis. Annals of Oncology 2006;17: 507514

Trombocitopenia
Consumo Esplenomegalia Dilucional Disfn

ASCO: 40-50 000: cx 20 000: bp medular 10 000: PL 100 000: neurocx

Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient part 2: systemsbased approach to anesthesia. Pediatr Anesth 2010; 20:396-420

Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient Part 3: pain, cognitive dysfunction, and preoperative evaluation. Pediatr Anesth 2010; 20:479-489

Potencialmente letal Destruccin masiva de cel tumorales

Liberacin masiva: ac. nucledos, K, P

Tu hematolgicos: LLA y linfoma

Burghi G, Berrutti B, Manzanares W. Tumor lysis syndrome in intensive therapy: diagnostic and therapeutic encare. Med Intensiva. 2011;35(3): 170178

Burghi G, Berrutti B, Manzanares W. Tumor lysis syndrome in intensive therapy: diagnostic and therapeutic encare. Med Intensiva. 2011;35(3): 170178

Causas:

Espontneo Radio- Quimio Fiebre Cx Anestesia


Dexametasona

Burghi G, Berrutti B, Manzanares W. Tumor lysis syndrome in intensive therapy: diagnostic and therapeutic encare. Med Intensiva. 2011;35(3): 170178

Burghi G, Berrutti B, Manzanares W. Tumor lysis syndrome in intensive therapy: diagnostic and therapeutic encare. Med Intensiva. 2011;35(3): 170178

Hiperkalemia, Hiperuricemia, Hiperfosfemia, Hipocalcemia IRA


Multifactorial Mecanismos:

Formacin de cristales: urato y fosfato-calcio VC Tto antineoplsico

Burghi G, Berrutti B, Manzanares W. Tumor lysis syndrome in intensive therapy: diagnostic and therapeutic encare. Med Intensiva. 2011;35(3): 170178

Fluidos: 3 litros/m2/da

Diuresis > 1ml/kg/hr Furosemida

Calcio Alopurinol TRR

LINFOMA, Timoma, Teratoma

Sndrome vena cava


Edema, cianosis EESS, cara y cuello

Sndrome mediastnico superior


Sincope, disnea, tos, disfagia,

ortopnea

Evaluar VA
1.Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient part 2: systems-based approach to anesthesia. Pediatr Anesth 2010; 20:396-420 2. Stricker P , Gurnaney H, et cols. Anesthetic management of children with an anterior mediastinal mass. J Clin Anesthesia 2010; 22:159 163

1. Stricker P , Gurnaney H, et cols. Anesthetic management of children with an anterior mediastinal mass. J Clin Anesthesia 2010; 22:159163 2. Slinger P, Karsli C.Management of the patient with a large anterior mediastinal mass: recurring myths 2007; Curr Opin Anaesthesiol 20:13

Tcnica menos invasiva


Sedacin AG: mantener ventilacin espontnea en induccin

Preparar pacte:

Pretratar con irradiacin torcica Corticoides 10-30% resistencia LLA

Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient part 2: systems-based approach to anesthesia. Pediatr Anesth 2010; 20:396-420

Compresin de VA:

Reposicionar pacte Broncoscopa rgida

Compresin CV:

Esternotomia y elevacin de masa

Slinger P, Karsli C.Management of the patient with a large anterior mediastinal mass: recurring myths 2007; Curr Opin Anaesthesiol 20:13

Lerman J. Anterior mediastinal masses in children. Semin Anesth Perio M 2007; 26:133-140

sobrevivientes patologa crnica 40% condiciones severas

Mayor riesgo:

Cncer Enfermedad CV Disfuncin renal Problemas musculoesquelticas Endocrinopatas

Tu seos, cerebrales y Linfoma Hodgkin

Oeffinger, K Mertens A, Sklar C, et cols. Chronic Health Conditions in Adult Survivors of Childhood Cancer. N Engl J Med 2006; 12: 1572-82

Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient part 1: a review of antitumor Therapy anesthesia. Pediatr Anesth 2010; 20:295-304 Siegel R, Naishadham D, Jemal A. Cancer statistics 2012. CA Cancer J Clin 2012; 62:1029 Oeffinger, K Mertens A, Sklar C, et cols. Chronic Health Conditions in Adult Survivors of Childhood Cancer. N Engl J Med 2006; 12: 1572-82 Stricker P , Gurnaney H, et cols. Anesthetic management of children with an anterior mediastinal mass. J Clin Anesthesia 2010; 22:159163 Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient part 2: systems-based approach to anesthesia. Pediatr Anesth 2010; 20:396-420 Slinger P, Karsli C.Management of the patient with a large anterior mediastinal mass: recurring myths 2007; Curr Opin Anaesthesiol 20:13 Lerman J. Anterior mediastinal masses in children. Semin Anesth Perio M 2007; 26:133-140 Sahai S, Zalpour A. Preoperative Evaluation of the Oncology Patient. Med Clin N Am 2010; 403419 Evans P, Chisholm D. Anaesthesia and paediatric oncology. Curr Anaesth Crit Care 2008; 19: 5058 Latham G, Greenberg R. Anesthetic considerations for the pediatric oncology patient Part 3: pain, cognitive dysfunction, and preoperative evaluation. Pediatr Anesth 2010; 20:479-489
Burghi G, Berrutti B, Manzanares W. Tumor lysis syndrome in intensive therapy: diagnostic and therapeutic encare. Med Intensiva. 2011;35(3): 170178 Lalami Y, Paesmans M, Muanza F, et cols.Can we predict the duration of chemotherapy-induced neutropenia in febrile neutropenic patients, focusing on regimen-specific risk factors? A retrospective analysis. Annals of Oncology 2006;17: 507514