Anesthetic management of patients undergoing extrapleural pneumonectomy for mesothelioma.
OBJECTIVE
Extrapleural pneumonectomy is a radical and aggressive surgery that presents a great challenge to the thoracic anesthesiologist. This surgery is performed routinely by only a few centers in the world and this review represents our institution's experience in anesthetic care.


RESULTS
Prominent among the developing multimodal treatment options is the combination of extrapleural pneumonectomy with intraoperative intracavitary hyperthermic chemotherapy. Outcome survival benefits have recently been demonstrated for the less completely cytoreductive pleurectomy procedure when combined with intraoperative intracavitary hyperthermic chemotherapy and trials are well under way for extrapleural pneumonectomy plus intraoperative intracavitary hyperthermic chemotherapy. Anesthetic management of extrapleural pneumonectomy is further impacted by these developments.


CONCLUSIONS
Anesthetic management importantly contributes to containment of the perioperative complications of extrapleural pneumonectomy. An appreciation of the technical aspects and physiologic disruptions associated with extrapleural pneumonectomy is critical to effective management. While data on this relatively uncommon surgical procedure are scarce, some referral centers have accumulated extensive experience. This review summarizes relevant surgical aspects and anesthetic insights from the Brigham and Women's Hospital experience. Included are the anesthetic implications of intraoperative intracavitary hyperthermic chemotherapy in combination with extrapleural pneumonectomy - an emerging therapeutic option in the treatment of malignant pleural mesothelioma.
Ng
Ju-Mei
JM
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Hartigan
Philip M
PM
D000758:Anesthesia / Q000379:methods*; D001145:Arrhythmias, Cardiac / Q000209:etiology; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods; D008654:Mesothelioma / Q000601:surgery*; D017202:Myocardial Ischemia / Q000209:etiology; D010148:Intractable Pain / Q000628:therapy; D018579:Patient Selection; D010997:Pleural Neoplasms / Q000601:surgery*; D011013:Pneumonectomy / Q000379:methods*; D018570:Risk Assessment