title: Staged intraperitoneal brachytherapy and hyperthermic intraperitoneal chemotherapy in an adolescent: novel anesthetic challenges for pediatric anesthetists.
abstract: Newer techniques that have found a place in cancer management in adults are offered far less commonly in pediatric patients. We present a case of a patient with recurrent Wilms' tumor managed with a novel combination of cytoreductive surgery, intraperitoneal brachytherapy, and subsequent hyperthermic intraperitoneal chemotherapy. Each stage presents challenges that the pediatric anesthetist is unlikely to have faced before. Such cases require flexibility and thorough planning to manage the combination of major surgery, remote anesthesia with brachytherapy and hyperthermic chemotherapy with its potential for metabolic derangement, significant fluid shifts, analgesic care, and potential exposure of staff to cytotoxic agents. Comprehensive care can be offered in pediatric centers.
authors.affiliation: Department of Anaesthesia, The Children's Hospital at Westmead, Sydney, Australia.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Weatherall
authors.affiliation: Department of Anaesthesia, Middlemore Hospital, Auckland, New Zealand.
authors.forename: Tristan R
authors.initials: TR
authors.lastname: Bennett
authors.affiliation: Department of Anaesthesia, The Children's Hospital at Westmead, Sydney, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Lovell
authors.affiliation: Department of Anaesthesia, The Children's Hospital at Westmead, Sydney, Australia.
authors.forename: Winnie
authors.initials: W
authors.lastname: Fung
authors.affiliation: Department of Anaesthesia, The Children's Hospital at Westmead, Sydney, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: de Lima
mesh_terms: D000293:Adolescent; D000768:Anesthesia, General / Q000379:methods*; D001918:Brachytherapy / Q000379:methods*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D005283:Fentanyl; D006801:Humans; D006979:Hyperthermia, Induced; D007268:Injections, Epidural; D007668:Kidney; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D008297:Male; D008738:Methyl Ethers; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy; D010537:Peritoneum; D015742:Propofol; D000077149:Sevoflurane; D016896:Treatment Outcome; D009396:Wilms Tumor / Q000188:drug therapy* / Q000532:radiotherapy*
chemical_list: D008738:Methyl Ethers; D000077149:Sevoflurane; D005283:Fentanyl; D015742:Propofol
keywords: anesthesia; brachytherapy; cytoreduction surgical procedures; hyperthermic intraperitoneal chemotherapy; pediatrics