David P. Myers

Interpleural analgesia for the treatment of severe cancer pain in terminally ill patients

Interpleural analgesia was used to alleviate acute, severe exacerbations of chronic pain unrelieved by pharmacologic therapy in ten terminally ill cancer patients. Pain from metastatic disease to the neck, arms, chest, brachial plexus, thorax, or abdomen was effectively eliminated between 7 hr and 40 days in nine patients, who died with minimal or no pain. The technique was performed primarily using bupivacaine. No side effects were detected. Interpleural analgesia appears to be effective in rapidly controlling acute exacerbations of cancer pain in terminally ill patients. Moreover, it may also be a suitable therapy for moribund patients when used as a continuous-infusion technique.

Bilateral pneumothoraces from a malfunctioning resuscitation valve

Disposable resuscitation valves appear as relatively simple devices used to ventilate patients during both emergent situations and transport from the operating room to the intensive care unit. We report a case of a nonfunctional disposable resuscitation valve that resulted in barotrauma and bilateral pneumothoraces. A routine check for proper function of these valves before use in critically ill patients may help to eliminate such cases.

Interpleural analgesia and neurolysis

Interpleural analgesia can be effectively utilized for the management of acute postoperative pain and severe exacerbations of chronic benign and malignant pain. It has been especially beneficial in the management of severe malignant pain unrelieved by pharmacologic therapy. Indications, contraindications, methods of insertion, dosing regimens and complications are reviewed here. In addition, the role of neurolysis is discussed.

Complications in the Oncological Patient

OMPLICATIONS in the oncological patient undergoing surgery comprise three major areas of concern for the anesthesiologist. First, the type and extent of the tumor and whether organs are involved can have a profound impact on the management and outcome of the anesthetic. Second, the patients chemotherapy regimen can interact with drugs given by the anesthesiologist. Third, radiation treatment can markedly alter the course of surgery and recovery. As with all patients undergoing surgery, a preoperative assessment should address the patients general background health, extent of cancer growth, and treatment history. A close scrutiny of these areas will help to select an appropriate management course. This evaluation of the major organ system function may alter the need for invasive monitoring as well as for postoperative pain requirements (patient-controlled analgesia [PCA] v epidural analgesia).