title: Anesthetic management and renal function in pediatric patients undergoing cytoreductive surgery with continuous hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin.
abstract: BACKGROUND
  Extensive tumor implants secondary to sarcoma, sarcomatosis, or mesothelioma in children is rare. We conducted the first phase 1 trial of escalating doses of cisplatin during hyperthermic intraperitoneal chemotherapy (HIPEC) in children with sarcomatosis. The most devastating complication of cisplatin therapy is nephrotoxicity. Here we present the anesthetic management and analysis of the impact of intraoperative fluid management on the incidence of renal failure.
  
  
  METHODS
  Of the 10 patients under 18 years of age who underwent HIPEC in the context of our phase 1 trial, six patients were under the age of 10 years. We reviewed the anesthetic management, intraoperative fluid and blood administration, and postoperative renal function in these patients.
  
  
  RESULTS
  The average age and weight were 6 years and 20.9 kg, respectively. To avoid renal toxicity, urine output was maintained at an average of 3 ml/kg/h. Crystalloid and colloid were transfused at an average rate of 9 ml/kg/h. Percentage increase in creatinine postoperatively varied from 33 to 500 %. Volume of fluid administered did not correlate with percentage increase in creatinine. All patients had a temporary increase in their serum creatinine, but none required dialysis.
  
  
  CONCLUSIONS
  Fluid administration at an average rate of 9 ml/kg/h was required to maintain satisfactory urine output. This rate of intraoperative fluid administration is similar to what is provided to adult HIPEC patients. There was no significant correlation in the volume or type of fluid delivered and the increase in serum creatinine. More studies are needed to determine optimal fluid management in children undergoing HIPEC with cisplatin.
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA. poagyemang@mdanderson.org
authors.forename: Pascal
authors.initials: P
authors.lastname: Owusu-Agyemang
authors.forename: Radha
authors.initials: R
authors.lastname: Arunkumar
authors.forename: Holly
authors.initials: H
authors.lastname: Green
authors.forename: Darline
authors.initials: D
authors.lastname: Hurst
authors.forename: Kathryn
authors.initials: K
authors.lastname: Landoski
authors.forename: Andrea
authors.initials: A
authors.lastname: Hayes-Jordan
mesh_terms: D000293:Adolescent; D000328:Adult; D000777:Anesthetics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000009:adverse effects*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects*; D007677:Kidney Function Tests; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D051437:Renal Insufficiency / Q000209:etiology* / Q000517:prevention & control*; D012509:Sarcoma / Q000628:therapy*; D055815:Young Adult
chemical_list: D000777:Anesthetics; D000970:Antineoplastic Agents; D002945:Cisplatin