title: Anaesthetic management of cytoreductive surgery followed by hyperthermic intrathoracic chemotherapy perfusion.
abstract: BACKGROUND
  Macroscopic cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion (HITHOC) is a new multimodal approach for selected patients with primary and secondary pleural tumors, which may provide the patient with better local tumor control and increased overall survival rate.
  
  
  METHODS
  We present a single-center study including 20 patients undergoing cytoreductive surgery and HITHOC between September 2008 and April 2013 at the University Medical Center Regensburg, Germany. Objective of the study was to describe the perioperative, anaesthetic management with special respect to pain and complication management.
  
  
  RESULTS
  Anaesthesia during this procedure is characterized by increased intrathoracic airway and central venous pressure, hemodynamic alterations and the risk of systemic hypo- and hyperthermia. Securing an adequate intravascular volume is one of the primary goals to prevent decreased cardiac output as well as pulmonary edema. Transfusion of packed red blood cells (PRBC) was necessary in seven of 20 (35%) patients. Only two patients (10%) showed an impairment of coagulation in postoperative laboratory analysis. Perioperative forced diuresis is recommended to prevent postoperative renal insufficiency. Supplementary thoracic epidural analgesia in 13 patients (65%) showed a significant reduction of post-operative pain compared with peroral administration of opioid and non-opioid analgesics.
  
  
  CONCLUSIONS
  This article summarizes important experiences of the anaesthesiological and intensive care management in patients undergoing HITHOC.
authors: Department of Anaesthesiology, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany. christoph.kerscher@gmx.net.
authors: Christoph
authors: C
authors: Kerscher
authors: Michael
authors: M
authors: Ried
authors: Hans-Stefan
authors: HS
authors: Hofmann
authors: Bernhard M
authors: BM
authors: Graf
authors: York A
authors: YA
authors: Zausig
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000758:Anesthesia; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002945:Cisplatin / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D035423:Thoracic Cavity
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin