Radiotherapy to Wilms' Tumor Excision

Summary

CO-EXISTING DISEASES

1. ▪ Brain tumors

2. ▪ Assoc neuro problems: ICP, seizures, cranial nerve involvement

3. ▪ Bone marrow depression or cardiotoxicity from chemotx

PREOPERATIVE ASSESSMENT

1. ▪ Studies: none

2. ▪ Premed: usually none

3. ▪ NPO: std; make sure treatments are scheduled early in AM so pt doesn't need to be NPO for very long

4. ▪ If two treatments per day, allow liberal clears up to 2 hours before afternoon tx

PROCEDURAL CONSIDERATIONS

1. ▪ Position: supine or prone

2. ▪ Absolute immobility needed

3. ▪ Often use constricting face mask that interferes with airway

4. ▪ Procedure lasts 4–15 min: 1 or 2 sessions a day.

5. ▪ Tx can last up to 6 weeks.

6. ▪ Gamma knife: stereotactic radiotx for vascular malformation or brain tumor involves placement of head frame, CT & MRI

7. ▪ Pts may need sedation while waiting for computation of orientation of radiation.

8. ▪ IV fluids: any at maintenance

9. ▪ Monitors: remote-controlled TV camera used to observe monitors; standard monitors & nasal cannula with capnograph

10. ▪ Risks: airway obstruction, pt movement during tx

ANESTHETIC PLAN

1. ▪ Pts usually have existing long-term indwelling IV access; if not consider placement of PICC line at 1st tx.

2. ▪ Induction: propofol 2–3 mg/kg IV slowly while maintaining spont ventilation

3. ▪ Alternatives: ketamine or inhalation agents

4. ▪ Intubation best avoided

5. ▪ Maintenance: propofol 200–300 mcg/kg/min

6. ▪ Pts usually go home shortly after emergence

7. ▪ Adjuvant tx: consider PO or IV anticholinergic agents for excessive drooling (eg, glycopyrrolate 0.01 mg/kg/IV)