title: Anesthetic management in patients undergoing hyperthermic chemotherapy.
abstract: OBJECTIVE
  Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has become an important therapeutic option for selected patients with peritoneal surface malignancies. This aggressive multimodality treatment is complex, not only regarding surgical technique, but also regarding anesthesia. The present review represents our experience in anesthetic care.
  
  
  RESULTS
  Improved prognosis compared with systemic chemotherapy alone has recently been demonstrated for cytoreductive surgery when combined with intraoperative intracavitary hyperthermic chemotherapy. Anesthetic management of HIPEC is further impacted by these developments. In addition to the ambitious, long-lasting surgery, HIPEC causes significant fluid, blood and protein losses, increased intra-abdominal pressure, systemic hyperthermia, and increased metabolic rate, leading to relevant pathophysiological alterations, and therefore represents a challenge for anesthetist and critical care physicians.
  
  
  CONCLUSIONS
  Anesthetic management importantly contributes to the containment of the perioperative complications of HIPEC. An appreciation of the technical aspects and physiologic disruptions associated with intra-abdominal HIPEC is critical to ensure effective anesthetic management. Although data on this specialized surgical procedure are scarce, some referral centers have accumulated extensive experience. This article reviews the current knowledge about the anesthesiological and intensive care management of patients undergoing HIPEC. It pinpoints strategies for perioperative monitoring as well as illustrates alterations in hemodynamic, hematopoetic, and fluid hemostasis.
authors.affiliation: Department of Anesthesiology and Operative Intensive care Medicine, University of Halle-Wittenberg, Halle, Germany. christoph.raspe@uk-halle.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Raspe
authors.forename: Pomipilu
authors.initials: P
authors.lastname: Piso
authors.forename: Christoph
authors.initials: C
authors.lastname: Wiesenack
authors.forename: Michael
authors.initials: M
authors.lastname: Bucher
mesh_terms: D000758:Anesthesia; D001777:Blood Coagulation / Q000502:physiology; D001831:Body Temperature / Q000502:physiology; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D003131:Combined Modality Therapy; D005440:Fluid Therapy; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D059408:Pain Management; D019990:Perioperative Care; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000628:therapy*; D011182:Postoperative Care