Anesthesia and Hospital Coordination

Abstract

Intraoperative radiotherapy is a treatment modality designed to combine the efforts of surgery and radiotherapy to increase local tumor control rates in cancer therapy. The possibility of treating during cancer surgery different areas with electron beams, delivering high single doses of radiation, while normal uninvolved tissues are mobilized or protected, has been attractive to both surgeons and radiotherapists. Other advantages of IORT are better delineation of the area involved by tumor and a reduction in tumor burden by surgical resection. Several aspects of this modality are of particular interest to anesthesiologists (FRIESEN et al. 1987):

• The anesthetic procedure involves a high risk because of the patients’ poor physical status, which is caused by both their disease and previous treatment modalities such as surgery, external beam radiotherapy, and chemotherapy.

• Major tumor resections involve very aggressive surgery of long duration.

• It is necessary to perform the surgery in the operating room, then to transport the anesthetized patient, with an open surgical wound (not exposed), through halls, elevators, and public spaces to reach and return from the linear accelerator room.

• The anesthetized patient is treated in a linear accelerator while all attendant personnel are away from the immediate vicinity of the patient during irradiation.

• Radiation treatment adds approximately 60 min to the anesthetic time, of which 45 min are spent outside the operating room.