scholarly journals Anaesthetic Management of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC): A True Challenge To an Anaesthetist

2020 ◽  
Vol 3 (07) ◽  
pp. 503-507
Author(s):  
Dr. Roly Mishra ◽  
Dr.Kritika Sharma ◽  
Dr Jueeli Barpande ◽  
Dr Nitu Kumari ◽  
Dr. Hemant Mehta
Keyword(s):  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Perioperative Management ◽  
Renal Toxicity ◽  
Fluid Management ◽  
Anaesthetic Management ◽  
Major Surgery ◽  
Poor Survival ◽  
Arterial Blood

Patients diseased with gynecological malignancies were believed untreatable with poor survival chances till hyperthermic intraperitoneal chemotherapy after capital cytoreductive surgery came into existence. Perioperative management of this patient, for a major surgery like CRS/HIPEC is complex and challenging. Major perioperative concerns in these patients include anesthetic challenges intraoperative fluid management, maintaining mean arterial blood pressure, thermoregulation electrolyte imbalances, significant blood loss and fluid shifts and renal toxicity after chemotherapeutic drugs administration. We report a case of 66 year old female diagnosed with carcinoma ovary with moderate ascites posted for cytoreductive surgery and HIPEC.

scholarly journals Physiologic and hemodynamic changes in patients undergoing open abdominal cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052098326
Author(s):  
Myoung Hwa Kim ◽  
Young Chul Yoo ◽  
Sun Joon Bai ◽  
Kang-Young Lee ◽  
Nayeon Kim ◽  
...  
Keyword(s):  
Body Temperature ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Resistance Index ◽  
Volume Index ◽  
Hemodynamic Changes ◽  
Arterial Blood

Objective We aimed to determine the physiological and hemodynamic changes in patients who were undergoing hyperthermic intraperitoneal chemotherapy (HIPEC) cytoreductive surgeries. Methods This prospective, observational study enrolled 21 patients who were undergoing elective cytoreductive surgery with HIPEC at our hospital over 2 years. We collected vital signs, hemodynamic parameters including global end-diastolic volume index (GEVI) and extravascular lung water index (ELWI) using the VolumeView™ system, and arterial blood gas analysis from all patients. Data were recorded before skin incision (T1); 30 minutes before HIPEC initiation (T2); 30 (T3), 60 (T4), and 90 (T5) minutes after HIPEC initiation; 30 minutes after HIPEC completion (T6); and 10 minutes before surgery completion (T7). Results Patients showed an increase in body temperature and cardiac index and a decrease in the systemic vascular resistance index. GEDI was 715.4 (T1) to 809.7 (T6), and ELWI was 6.9 (T1) to 7.3 (T5). Conclusions HIPEC increased patients’ body temperature and cardiac output and decreased systemic vascular resistance. Although parameters that were extracted from the VolumeView™ system were within their normal ranges, transpulmonary thermodilution approach is helpful in intraoperative hemodynamic management during open abdominal cytoreductive surgery with HIPEC. Trial registry name: ClinicalTrials.gov Trial registration number: NCT02325648 URL: https://clinicaltrials.gov/ct2/results?cond=NCT02325648&term

scholarly journals Anaesthetic Management of Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei: A Retrospective Audit

2017 ◽  
Vol 45 (4) ◽  
pp. 490-498 ◽  
Author(s):  
S. P. Shiralkar ◽  
P. Kerr ◽  
J. Scott ◽  
P. Sivalingam
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Pseudomyxoma Peritonei ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Survival Rates ◽  
Anaesthetic Management ◽  
Retrospective Audit ◽  
Significant Difference

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to improve quality of life and survival rates in patients suffering from pseudomyxoma peritonei. The procedure is long and associated with significant intraoperative blood loss. As such, the anaesthetic management of patients undergoing this procedure can be challenging. The aim of this paper is to describe our perioperative management of pseudomyxoma peritonei patients who received CRS and to report a retrospective audit of our outcomes and complications over a six-year period at a large tertiary centre. A total of 70 patients were included, of whom three (4.3%) had CRS alone, 42 (60.0%) had CRS with HIPEC, and 25 (35.7%) had CRS with HIPEC and early postoperative intraperitoneal chemotherapy. There were no intraoperative deaths. A total of four patients (5.7%) died during their hospital admission. At one-year follow-up, six patients (9.0%) had died, and at the end of the study 15 (22.4%) had died. No statistically significant difference in blood loss was seen between patients who received tranexamic acid (30 patients, 42.9%) and those who did not, but the incidence of deep venous thrombosis was much higher (10/30 versus 1/40). Different intravenous fluid strategies appeared not to influence the incidence of postoperative acute renal failure. Further research is required to evaluate the effects of intraoperative tranexamic acid and different intraoperative fluid strategies on outcomes in patients undergoing CRS with HIPEC.

scholarly journals Is Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Indicated in Hepatobiliary Malignancies?

2020 ◽  
Author(s):  
Natasha Leigh ◽  
Daniel Solomon ◽  
Eric Pletcher ◽  
Daniel M. Labow ◽  
Deepa R. Magge ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Survival Benefit ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Systemic Chemotherapy ◽  
Oncologic Outcomes ◽  
Poor Survival ◽  
Current Therapies

Abstract Background Hepatopancreaticobiliary malignancies with peritoneal carcinomatosis (PC) exhibit poor survival with current therapies; HCC 11 months with sorafenib, pancreaticobiliary 9-14 months with systemic chemotherapy. Methods We retrospectively reviewed our institutional hepatopancreaticobiliary malignancies with PC which underwent CRS/HIPEC from 2007-2017 and analyzed perioperative and oncologic outcomes. Results 17 patients were included; 9 HCC, 8 pancreaticobiliary (4 cholangiocarcinoma, 3 gallbladder, 1 pancreatic). PCI (12 vs. 9), completeness of cytoreduction (78% vs. 75%) and 30-day morbidity (11% vs. 13%) were equivalent. HCC received less neoadjuvant therapy (11% vs. 75%, p=0.008), though adjuvant therapy rates were similar (78% vs. 100%, p=0.156). At a median follow-up of 15 months, PFS was similar (7 vs. 10 months p=0.957). However, OS was longer in HCC (42 vs. 15 months p=0.206) with 59% 3-year OS (vs. 0% pancreaticobiliary). Conclusions CRS/HIPEC may offer a survival benefit in select HCC patients with PC, though has dubious utility in PB malignancies.

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