Palliative Care

Development of medical knowledge and technology empowers both patients and physicians to seek interventions, thus improving the quality of life for patients facing palliative conditions. Many patients with life-threatening illnesses will encounter Anesthesia services during their medical journey. Pulmonary stents or palliative radiation therapy may relieve shortness of breath caused by a tumor compressing the flow of air into the lungs; bowel surgery and stoma creation can reduce symptoms of nausea and bowel obstruction related to metastatic abdominal disease; brain surgery or palliative chemotherapy and radiation may control severe headaches, seizures or other disabilities caused by a brain tumor. A surgical stabilization or vertebroplasty are recommended for comfort care in patients with pathological bone fractures. Because prognosis of an illness can be unclear, many patients and their physicians face challenging decision related to appropriateness, risks versus benefits, or possible futility of medical interventions. Anesthesiologists possess multiple competencies necessary to ensure optimal medical care for patients with terminal disease. These include, however, are not limited to: good understanding of proposed treatments, disease trajectory, cardio-pulmonary reserve assessment, patient optimization, and the provision of an expert opinion facilitating decision making in the context of patient goals of care.

Anesthesiologists are recognized pain management experts offering consulting services to pediatric and adult patients with severe cancer related pain. Patients with inadequate response to traditional interventions, as outlined by the World Health Organization Analgesia Ladder, may benefit from more advanced treatment options including: neuraxial analgesia, targeted nerve ablation, or peripheral nerve blocks using continuous infusion catheters. The neuraxial catheters, tunneled under the skin, deliver anesthetic and opioid mixture blocking the pain signaling pathway at the level of the spinal canal. This intervention can help reduce doses of systemic opioids and opioid related side effects.  Palliative physicians can request an Anesthesia consultation after careful consideration of potential procedural risks and benefits, adequate patient screening and family education.  The goal of these interventions is to allow patients with complex pain symptoms achieve better symptom control and return to the comfort of a private home or hospice