Osteosarcoma in a 20 Year Old Male Posted for Tumor Excision and Total Knee Replacement: Anaesthetic Concerns with Review of Literature

Abstract

Osteosarcoma is the most common bone sarcoma having an incidence of 4.6 per million occurring more commonly in the adolescent age group. Treatment of osteosarcoma consists of neoadjuvant chemotherapy for about 10 weeks before and after the reconstructive surgery carried out to salvage the affected limb. The limb saving surgical treatment of osteosarcoma consists of tumour resection and limb reconstruction with a bone graft or endoprosthesis. We hereby discuss the anaesthetic management of a young adult with distal femur osteosarcoma posted for tumour resection and implant of an endoprosthesis with the help of general anaesthesia with adequate perioperative pain management with systemic opioids, paracetamol and epidural analgesia. Optimal haemodynamic management with the help of invasive monitoring helped us not only to manage the perioperative fluid requirements but also kept us vigilant against any untoward side effects of bone cement implantation syndrome. Use of low molecular weight heparin also helped us achieve adequate thrombophrophylaxis in the post-operative period.