新型癌症疗法:围手术期的影响和挑战。

Cristina Gutierrez,Prabalini Rajendram,Olakunle Idowu
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引用次数: 0

摘要

自免疫疗法和靶向疗法问世以来,患者不仅对这些疗法产生了充分的肿瘤反应,而且由于毒性较轻,他们的生活质量也得到了改善。然而,由于其作用机制广泛,这些疗法的毒性特征也很广泛,可能会隐匿发病,而且识别起来也很困难。在极少数情况下,如果不及早诊断,其中一些毒性反应可能会导致严重的发病率,并导致患者进入重症监护室(ICU)和死亡。麻醉医生不仅可能会遇到各种各样的这些毒性反应,而且其严重程度也各不相同。在某些情况下,他们可能是第一个做出诊断的人,因此需要做好准备,迅速进行评估、确定鉴别、执行诊断工作并评估毒性对围术期患者护理的影响。在本文中,我们将回顾新型癌症疗法(如检查点抑制剂和靶向疗法)可能在围手术期出现的毒性。本文将为麻醉医师认识其临床表现、诊断方法及其对患者护理的影响提供指导。
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Novel Cancer Therapeutics: Perioperative Implications and Challenges.
Since the introduction of immunotherapy and targeted therapies, patients not only have adequate tumoral response to these treatments, but their quality of life has improved due to milder toxicities. However, due to their wide mechanisms of action, the toxicity profile for these therapies is broad, can have an insidious onset, and their recognition can be challenging. Rarely, some of these toxicities can cause significant morbidity if not diagnosed early and lead to intensive care unit (ICU) admission and death. Anesthesiologists are likely to encounter not only a wide spectrum of these toxicities but also a wide range of severity. In some cases, they could be the first to make the diagnosis and therefore need to be prepared to rapidly assess, establish differentials, perform a diagnostic workup, and evaluate the impact the toxicity could have on the patients' care during the perioperative period. In this article, we set to review toxicities of novel cancer therapies such as checkpoint inhibitors and targeted therapies, that could present in the perioperative setting. This article will help as a guide for anesthesiologists to recognize their clinical presentation, the approach to their diagnosis, and their impact on patient care.
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