Preoperative Anesthesia Evaluation

Plastic and Reconstructive Surgery Department physicians operate on some noncancer patients, our Pediatric and Neurosurgery Departments follow patients with neuroflbromatosis, and patients who have had prior treatment at M.D. Anderson Cancer Center return for surgery of such nonmalignant conditions such as cholecystectomy or eye surgery). Prior treatments for malignancy-whether surgical, chemotherapeutic, or radiotherapeutic-can affect a patient's response to anesthesia and surgery. Additionally, certain tumors can cause physiological disturbances by virtue of their secretory potentials, paraneoplastic syndromes, or because of simple mass effect (e.g., increased intracranial pressure from a space-occupying mass). Adverse effects due to secretory products include: "tumor fever" from cytokine release (9), hypotension and bronchospasm from metastatic carcinoid tumors (10), and hypermetabolic syndromes from thyroid cancers (11) or pheochromocytoma (12). Adverse effects of paraneoplastic syndromes include: Eaton-Lambert syndrome (13), cancer-associated retinopathy (14), hypercalcemia of malignancy syndrome (15), and complex regional pain syndromes (16).