18 - Procedural Care of the Adult Cancer Patient Outside of the Operating Room

Abstract

The cancer patient often requires complex diagnostic, therapeutic, and palliative care procedures in nonoperating room sites, which have created an increasing demand for anesthesia services in remote locations outside of the traditional operating room (OR). Remote areas requiring anesthesia continues to expand, and anesthesia services are now frequently requested for endoscopy, diagnostic radiology, interventional radiology (IR), radiation oncology, nuclear medicine as well as for procedures such as bone marrow aspiration and biopsy. Technological advancement and movement toward minimally invasive approaches have moved procedures that were once performed in the OR to nonoperating room locations. Historically, patients in these remote locations were given conscious sedation by a certified nurse under the supervision of the proceduralist. The relationship between anesthesia services and proceduralists can be complex and challenging, requiring that the medical specialties gain familiarity with one another. The proceduralists and personnel in remote areas must be familiar with the anesthesia practice guidelines and standards of anesthesia to promote the highest level of safety possible for the patient. The anesthesiologist must be knowledgeable of the procedure, treatment or imaging technique, potential complications, and the anesthetic needs required for a successful procedure, treatment, or scan. The increased need for anesthesia in complex diagnostic, therapeutic, and palliative procedures performed in the cancer patient has created a demand for expertise in non-OR anesthesia (NORA). This chapter discusses the principles of sedation and analgesia as well as the role and challenges of the anesthesia team, while providing services in the various NORA locations, such as diagnostic radiology, IR, interventional gastroenterology and endoscopy (GI), and radiation therapy (RT).