Peri-operative anaesthetic management of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is a long and complex procedure with significant blood and fluid loss during debulking and important pathophysiological alterations during the HIPEC phase. We performed a retrospective analysis of 78 consecutive patients undergoing cytoreductive surgery with HIPEC at a university hospital. Our data demonstrate large intra-operative fluid turnover, with 51% of patients requiring a blood transfusion. During HIPEC, airway pressure and central venous pressure increased with a lower oxygenation ratio as a result of increased intra-abdominal pressure with the closed abdomen technique. As a consequence of the raised body temperature, heart rate, end tidal carbon dioxide and arterial lactate levels increased with a slight metabolic acidosis. Peri-operative analysis of routine clotting parameters revealed disturbances of the coagulation status. For pain management, 72% of patients received supplementary thoracic epidural analgesia with consequential peri-operative opioid sparing and a reduced duration of postoperative ventilation.
Schmidt
C
C
Department of Anaesthesiology, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany. christoph_schmidt2001@yahoo.de
Creutzenberg
M
M
Piso
P
P
Hobbhahn
J
J
Bucher
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000768:Anesthesia, General / Q000379:methods*; D001777:Blood Coagulation; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000097:blood; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006339:Heart Rate; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D019990:Perioperative Care / Q000379:methods*; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000601:surgery*; D012189:Retrospective Studies
D002245:Carbon Dioxide; D010100:Oxygen