title: Anesthesia management of patients undergoing hyperthermic isolated limb perfusion with melphalan for melanoma treatment: an analysis of 17 cases.
abstract: BACKGROUND
  Hyperthermic isolated limb perfusion (HILP) is used for patients with intractable or extensive in-transit metastatic melanoma of the limb to deliver high concentrations of cytotoxic agents to the affected limb and offers a treatment option in a disease stage with a poor prognosis when no treatment is given.
  
  
  METHODS
  In a retrospective chart review of 17 cases, we studied the anesthetic and hemodynamic changes during HILP and its management.
  
  
  RESULTS
  HILP was well tolerated except in one case that is described herein. We present summary data of all cases undergoing upper and lower limb perfusion, discuss our current clinical practice of preoperative, perioperative and intraoperative patient care including the management of HILP circuit.
  
  
  CONCLUSIONS
  HILP is a challenging procedure, and requires a team effort including the surgical team, anesthesia care providers, perfusionists and nurses. Intraoperatively, invasive hemodynamic and metabolic monitoring is indispensable to manage significant hemodynamic and metabolic changes due to fluid shifts and release of cytokines.
authors.affiliation: Department of Surgery, California Pacific Medical Center, San Francisco, CA, USA. LeongSX@cpmcri.org.
authors.forename: Heiner
authors.initials: H
authors.lastname: Ruschulte
authors.forename: Serena
authors.initials: S
authors.lastname: Shi
authors.forename: William W
authors.initials: WW
authors.lastname: Tseng
authors.forename: Kerstin
authors.initials: K
authors.lastname: Kolodzie
authors.forename: Philip C
authors.initials: PC
authors.lastname: Crawford
authors.forename: Darren B
authors.initials: DB
authors.lastname: Schneider
authors.forename: Mohammed
authors.initials: M
authors.lastname: Kashani-Sabet
authors.forename: David
authors.initials: D
authors.lastname: Minor
authors.forename: Christian
authors.initials: C
authors.lastname: Apfel
authors.forename: Stanley Pl
authors.initials: SP
authors.lastname: Leong