Percutaneous Isolated Hepatic Perfusion: Hemodynamic Monitoring and Goal-Directed Anesthetic Management: A Case Report.
The percutaneous isolated hepatic perfusion utilizes a venovenous bypass to administer high-dose chemotherapy exclusively in the liver, getting depurated through a hemofilter before returning to the systemic circulation. The hepatic perfusion is managed under general anesthesia and invasive monitoring as a result of very abrupt changes in venous return and vascular resistances because of the isolation of the hepatic territory and absorption of circulating catecholamines by the hemofilter. We report a case in which we describe the technique, physiologic implications, anesthetic, and goal-directed hemodynamic management for this procedure.
From the *Department of Anesthesia, Hospital Universitario Madrid-Norte Sanchinarro, Madrid, Spain; †Department of Anesthesia, Hospital Universitario de Madrid-Montepríncipe, Madrid, Spain; ‡Department of Surgery, Hospital Universitario Madrid-Norte Sanchinarro, Madrid, Spain; and §Department of Interventional Radiology, Hospital Universitario Madrid-Norte Sanchinarro, Madrid, Spain.
Oscar
O
Martin-Delgado
Miguel
M
Rodriguez
Andres
A
Lopez
Miguel A
MA
Reina
Emilio
E
De Vicente
Yolanda
Y
Quijano
Antonio
A
Echenagusia
Juan A
JA
Martinez
D000768:Anesthesia, General / Q000379:methods*; D018278:Carcinoma, Neuroendocrine / Q000098:blood supply / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000556:secondary; D002405:Catheterization, Central Venous; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D006439:Hemodynamics; D006440:Hemofiltration; D006801:Humans; D008102:Liver Circulation; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000556:secondary; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology*; D016896:Treatment Outcome