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Peri‐operative anaesthetic management of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy
Author(s) -
Schmidt C.,
Creutzenberg M.,
Piso P.,
Hobbhahn J.,
Bucher M.
Publication year - 2008
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.2007.05380.x
Subject(s) - medicine , hyperthermic intraperitoneal chemotherapy , anesthesia , debulking , surgery , central venous pressure , blood pressure , heart rate , cytoreductive surgery , cancer , ovarian cancer
Summary Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is a long and complex procedure with significant blood and fluid loss during debulking and important pathophysiological alterations during the HIPEC phase. We performed a retrospective analysis of 78 consecutive patients undergoing cytoreductive surgery with HIPEC at a university hospital. Our data demonstrate large intra‐operative fluid turnover, with 51% of patients requiring a blood transfusion. During HIPEC, airway pressure and central venous pressure increased with a lower oxygenation ratio as a result of increased intra‐abdominal pressure with the closed abdomen technique. As a consequence of the raised body temperature, heart rate, end tidal carbon dioxide and arterial lactate levels increased with a slight metabolic acidosis. Peri‐operative analysis of routine clotting parameters revealed disturbances of the coagulation status. For pain management, 72% of patients received supplementary thoracic epidural analgesia with consequential peri‐operative opioid sparing and a reduced duration of postoperative ventilation.