Since the introduction of immunotherapy and targeted therapies, patients not only have adequate tumoral response to these treatments, but their quality of life has improved due to milder toxicities. However, due to their wide mechanisms of action, the toxicity profile for these therapies is broad, can have an insidious onset, and their recognition can be challenging. Rarely, some of these toxicities can cause significant morbidity if not diagnosed early and lead to intensive care unit (ICU) admission and death. Anesthesiologists are likely to encounter not only a wide spectrum of these toxicities but also a wide range of severity. In some cases, they could be the first to make the diagnosis and therefore need to be prepared to rapidly assess, establish differentials, perform a diagnostic workup, and evaluate the impact the toxicity could have on the patients' care during the perioperative period. In this article, we set to review toxicities of novel cancer therapies such as checkpoint inhibitors and targeted therapies, that could present in the perioperative setting. This article will help as a guide for anesthesiologists to recognize their clinical presentation, the approach to their diagnosis, and their impact on patient care.

中文翻译：

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新型癌症疗法：围手术期影响和挑战。


自从引入免疫疗法和靶向疗法以来，患者不仅对这些治疗有足够的肿瘤反应，而且由于毒性较轻，他们的生活质量也有所改善。然而，由于它们的作用机制广泛，这些疗法的毒性特征很广泛，起效可能很隐匿，并且识别它们可能具有挑战性。极少数情况下，如果不及早诊断，其中一些毒性会导致严重的并发症，并导致重症监护病房 （ICU） 入住和死亡。麻醉师不仅可能会遇到各种各样的这些毒性，而且还可能会遇到各种严重程度。在某些情况下，他们可能是第一个做出诊断的人，因此需要准备好快速评估、建立鉴别诊断、进行诊断检查，并评估毒性对围手术期患者护理的影响。在本文中，我们着手回顾可能出现在围手术期的新型癌症疗法（例如检查点抑制剂和靶向疗法）的毒性。本文将有助于麻醉师识别他们的临床表现、诊断方法以及他们对患者护理的影响。