[Anesthetic management for scheduled peritonectomy and hyperthermic intraperitoneal chemotherapy in 20 patients].
OBJECTIVE
The aim of this study was to describe our protocol for the anesthetic management for peritonectomy and hyperthermic intraperitoneal chemotherapy and to report the results from a series of 20 patients.


METHODS
The patients were diagnosed with peritoneal carcinomatosis and classified ASA 1-3. A thoracic epidural catheter was inserted for invasive monitoring. We recorded duration of surgery, hemodynamic changes and the use of vasoconstrictors, requirement for intraoperative fluid replacement or blood product transfusion, diuresis, and use of diuretics.


RESULTS
Twenty patients were studied. Peritonectomy could not be performed in 3 patients and their data was excluded in order to avoid skewing. The mean (SD) duration of the intervention was 543 (98) minutes. Vasoconstrictors were used in 7 out of 17 patients (41%). Diuretics were used in 10 out of 17 patients (58%). Fluids infused during surgery were a mean of 7.9 (2) L of crystalloid solution and 2.3 (0.6) L of colloid solution. Packed red blood cells were transfused in 9 cases and only 1 patient required fresh frozen plasma. The temperature rose from 1-1.5 degrees C during administration of the hyperthermic chemotherapy and was controlled without complications with the infusion of cold liquids and a heating blanket set at 32-34 degrees C. Extubation inside the operating room was possible in 41% of the cases. Two patients developed postoperative respiratory problems and 1 patient, renal failure. One patient was reoperated for bleeding.


CONCLUSIONS
The described anesthetic management protocol allowed the intervention to be carried out without complications other than hypotension, which responded to vasoconstrictor therapy.
Pérez
J
J
Servicio de Anestesia, Reanimación y Terapia del Dolor, Hospital Clínico Universitario de Santiago de Compostela. juliapgil@yahoo.es
Rodríguez
M J
MJ
Campaña
O
O
Veiras
S
S
Lorenzo
D
D
Lamas
M
M
Alvarez
J
J
D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D000768:Anesthesia, General / Q000379:methods*; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D000932:Antiemetics / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage; D003102:Colloids / Q000008:administration & dosage; D003131:Combined Modality Therapy; D000077324:Crystalloid Solutions; D004232:Diuretics / Q000008:administration & dosage / Q000627:therapeutic use; D017707:Erythrocyte Transfusion; D005260:Female; D005334:Fever / Q000517:prevention & control; D005440:Fluid Therapy; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology; D007431:Intraoperative Complications / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D007552:Isotonic Solutions / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D016343:Monitoring, Intraoperative; D017239:Paclitaxel / Q000008:administration & dosage; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D010537:Peritoneum / Q000601:surgery*; D010949:Plasma; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use
D000932:Antiemetics; D003102:Colloids; D000077324:Crystalloid Solutions; D004232:Diuretics; D007552:Isotonic Solutions; D014662:Vasoconstrictor Agents; D016685:Mitomycin; D017239:Paclitaxel; D002945:Cisplatin; D005472:Fluorouracil