Anesthetic management in an appendix tumor patient undergoing hyperthermic chemotherapy

Year 2013, , 234 - 237, 01.06.2013

Yonca Yanlı Erdem Akçay Cafer Yürük Nurten Bakan

https://doi.org/10.5799/ahinjs.01.2013.02.0274

Abstract

Cytoreductive surgery combined with hyperthermic intra­peritoneal chemotherapy (HIPEC) is a complex and mul­tidiscipliner procedure that is being used increasingly for peritoneal and appendix malignency. First of all the mac­roscopic tumor tissues are extracted after that peritoneal perfusion is started with giving heated 42°C chemother­apeutic solution via abdominal drains. It is important to maintain normovolemia, to regulate coagulation and renal parameters during perioperative period, to compansate hypothermia during cytoreductive surgery and hyperther­mia during HIPEC and to regulate hemodynamic changes due to increased abdominal pressure during HIPEC. In this case report, we aimed to share anaesthetic experi­ence and to evaluate anaesthetic problems in 45 years old ASA I patient undergoing cytoreductive surgery and hypertermic intraperitoneal chemotherapy in which newly established in our hospital for appendix tumor. J Clin Exp Invest 2013; 4 (2): 234-237

Keywords

Anaesthesia, general, hyperthermic intraper­itoneal chemotherapy, cytoreductive surgery.

Hipertermik kemoterapi uygulanan apandis tümörü hastasında anestezik yaklaşım

Abstract

Sitoredüktif cerrahi ile birlikte uygulanan hipertermik intra­peritoneal kemoterapi (HİPEK), peritoneal ve apandise ait malignitelerde gittikçe artan oranda kullanılan, kompleks ve multidisipliner bir yöntemdir. Önce görülebilen bütün tümör dokuları çıkarılır, daha sonra 42°C\'ye ısıtılmış ke­moterapötik solüsyon, drenler yolu ile batına verilerek pe­ritoneal perfüzyon yapılır. Perioperatif dönemde normo­voleminin sürdürülmesi, sitoredüktif faz sırasında hipoter­minin, HİPEK sırasında hiperterminin kompanse edilmesi ve intraabdominal basıncın artmasına bağlı ortaya çıkan hemodinamik değişikliklerin regüle edilmesi, koagülasyon ve renal parametrelerin takip edilerek düzeltilmesi önem­lidir. Biz de nüks apandis müsinöz tümörü nedeniyle sitoredük­tif cerrahi ve HİPEK planlanan 45 yaşındaki ASA I erkek hastamız nedeniyle, hastanemizde yeni yapılmaya başla­nan bu yöntem konusundaki deneyimimizi paylaşmayı ve anestezi açısından oluşabilecek sorunları gözden geçir­meyi amaçladık.

Keywords

Anestezi, genel; hipertermik intrape­ritoneal kemoterapi; sitoredüktif cerrahi.

References

• Bell JC, Rylah BG, Chambers RW, et al.Perioperatif manegement of patients undergoing cytoreduc- tive surgery combined with heated intraperitoneal chemotherapy for peritoneal surface malinency:A multi-ınstitutional experience. Ann Surg Oncol 2012;19:4244-4251.
• Glockzin G, Schlitt HJ, Piso P. Peritoneal carcinoma- tosis: patient selection, perioperative complications and quality of life related to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. World J Surgical Oncol 2009;7:5-8.
• Yonemura Y, Elnemr A, Endou Y, et al. Multidisci- pliplinary therapy for treatment of patients with peri- toneal carsinomatosis from gastric cancer.World J Gastrointest Oncol 2010;15;2:85-97.
• Schmidt C, Creutzenberg M, Hobbhahn J, Bucher M. Peri-operative anaesthetic management of cytoreduc- tive surgery with hyperthermic intraperitoneal chemo- therapy. Anaesthesia 2008;63:389-95.
• Pretto G, Grando M, Junior NC, Bergold RA, de Castro RAC,Santiago A. Anesthesia for peritonectomy with hyperthermic intraperitoneal chemotherapy.Case re- port. Rev Bras de Anesthesiol 2010;60:551-557.
• Tang L, Mei LJ, Yang XJ, et al. Cytoreductive surgery plus intraperitoneal chemotherapy improves survival of gasric cancer with peritoneal carcinamatosis:evidence from an experimental study. J Translat Med 2011;9:53- 7.
• Scumann R, Wilson G, Hariskov S, et al. Impact of in- traoperative anesthetic and fluid management on 30- day postoperative outcomes in a newly established peritoneal surface malignancy program. J Anesth Clin Res 2012;3:244-248.