Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery in the Management of Peritoneal Carcinomatosis

Rahul Rajeev, MBBS; Kiran K. Turaga, MD

Disclosures

Cancer Control. 2016;23(1):36-46. 

In This Article

Anesthesia and Critical Care

Use of hyperthermia puts unique demands on patient physiology, and patients undergoing HIPEC are at increased risk for cardiac complications, particularly those with existing cardiovascular disease or associated risk factors.[48] In addition, chemoperfusion creates changes in intra-abdominal pressure that may increase systemic vascular resistance and affect cardiac output.[49] Chemotherapeutic drugs intraperitoneally administered possess their own toxicities (eg, nephrotoxicity with cisplatin) that may be accentuated by altered fluid dynamics. Fluid loss is also high during peritonectomy procedures due to loss from denuded areas.

Modern anesthetic techniques and stringent patient selection has made cytoreductive surgery/HIPEC feasible for patients at both extremes of age.[50,51] Advances in invasive and noninvasive fluid status monitoring and management, along with analgesic control with regional anesthesia, have contributed to reduced stays in the intensive care unit and improved perioperative outcomes.[50]

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