Skip to main content

Poster Presentation - Anesthetic management of a patient with Cancer and Hyperhomocysteinemia

Abstract

Case: A 57-year-old female with a history of uterine and breast cancer s/p chemoradiation presented for cervical LEEP/cone biopsy/D&C. Her medical history was complicated by elevated LFTs with recent hyperhomocysteinemia (> 50micromol/l, normal 4-15). She was seen by a hematologist prior to surgery, and it was concluded that elevated homocysteine levels were due to cancer therapy and alcohol consumption. The procedure was performed under monitored sedation, with 2mg of Midazolam, 50mcg of Fentanyl, and a bolus of 70mg of Propofol followed by a steady infusion of 150mcg/kg/min. 

Discussion: Causes of hyperhomocysteinemia include genetic predisposition, acquired deficiencies (folate, B6, B12), malignancies, and renal disease. Elevated homocysteine levels result in thromboembolic complications by causing endothelial dysfunction, increasing procoagulant activity, and decreasing the antithrombotic effect. Challenges of patients with hyperhomocysteinemia undergoing anesthesia are related mainly to the procoagulant state and efforts should be focused on thromboprophylaxis and maintenance of hemodynamics and euvolemia. Nitrous oxide should be avoided as it inhibits methionine synthase and can further increase homocysteine levels. Patients with co-morbidities that include coronary artery disease, peripheral vascular disease, and cerebrovascular disease are at increased risk for peri-operative thrombotic events. This risk is amplified for high-risk procedures under general anesthesia.

Conclusion: In this case, the patient presented for a low-risk procedure. She did not have a history of the coronary or cerebrovascular disease but had risk factors (surgery, age>50yrs, malignancy, cancer therapy) in addition to a hypercoagulable state (due to elevated homocysteine levels) that posed increased peri-operative risk for thrombotic events such as deep venous thrombosis and pulmonary embolus. The decision was made to proceed with monitored sedation over general anesthesia so as to avoid fluctuations in hemodynamics and decrease the risk of venous stasis. The procedure took approximately 45 minutes and the patient recovered uneventfully and was discharged home the same day.

Biography 
Dr. Yeoh is an Associate Attending in the Department of Anesthesiology and Critical Care Medicine at Memorial Sloan Kettering Cancer Center in New York. She is a member of the department’s Quality Assurance Committee and her research interests include patient safety, outcomes and performance, and technology in the field of anesthesiology. Her recent publications have focused on real-time locating systems and its effects on the efficiency of anesthesiologists in the perioperative setting.

Comments

Post a Comment

Popular posts from this blog

Poster Presentation - Influence of NECC (Nutrition and Exercise Center for Cancer Patients) on survival and body composition in Gastrointestinal Cancer Patients

Abstract BACKGROUND : Gastrointestinal cancer patients are particularly predisposed to develop cancer cachexia. Cachectic patients are characterized by loss of adipose tissue as well as skeletal muscle wasting which has a tremendous impact on quality of life and survival (1, 4). In terms of improvement for this multifactorial syndrome, Klinikum rechts der Isar (MRI) in Munich, Germany has founded NECC, a treatment concept including nutrition intervention and an individual training program. METHODS : In this study we focused on patients with pancreatic (n =15) and upper gastrointestinal cancer (n = 21). Body composition using CT images was analyzed initially, 4 weeks, 3 months and 6 months after initial visit of NECC (Image 1). To underline the outcome, NECC patients were matched to adequate partners who correspond in age, gender, diagnosis with TNM classification and type of surgery. The control group does not receive any further support concerning nutrition and physical exercise...
2 comments
Read more

Conference Venue

holiday Inn Rome - Aurelia,Via Aurelia Km, 8400 00165, Rome, Italy About City Rome is the capital city of Italy and Lazio region with 2,872,800 residents in 1,285 km2. It is the fourth most populous city in the European Union by population within city limits. Rome is located in central western Italian peninsulas. Rome has acquired the status of a global city. In 2016, Rome has been ranked as the 14th most visited cities in the world and 3rd most visited cities in Europe. It is a city that is proud of its ancient glorious heritage, a city that once expanded its empire throughout Europe, Africa and Asia. The city of Rome includes tourist places such as Colosseum, Pantheon, Spanish Steps, the Forum, Trevi Fountain, and the catacombs any of the buildings have arches, domes and vaults. Colosseum is one of the famous architecture symbols in Rome which is capable of housing 60,000 spectators and it is the largest amphitheater ever built in the Roman empire and it was used for gladia...
2 comments
Read more

Past Conference Report - Cancer Research

With great support from our Collaborators and Organizing Committee, PULSUS Conferences successfully completed the “Cancer 2018” which was held at Edinburgh, Scotland on March 26-27, 2018. We would like to thank our Keynote Speakers for the conference - Hiroshi Kobayashi , Chiba University, Japan, William T. Beck , University of Illinois, USA, Shalini Gupta , King George Medical College, India, Antonio Gomez-Munoz , University Of The Basque Country, Spain, Barbara DeVivo , Westmont University, USA. for their support in making this event a great success. We would like to extend our thanks to our collaborators “ Sudanese Medical Research Association ”, “ Uganda Cancer Society ” and “ Pharmaceutical Society of Uganda ” for their constant support. It wouldn’t have been possible without the support of our Media Partners who helped us in promoting this event. We thank our Media partners for their support in helping us reach a greater audience. We also would like to thank all o...
Post a Comment
Read more