Haemodynamic changes during hyperthermic intra-thoracic chemotherapy for pseudomyxoma peritonei

Area of Science:

• Oncology
• Cardiovascular Anesthesiology
• Surgical Oncology

Background:

• Pseudomyxoma peritonei with thoracic extension is a rare condition.
• Cytoreductive surgery (CRS) combined with hyperthermic intra-thoracic chemotherapy (HITOC) is an emerging treatment strategy.
• The haemodynamic effects of HITOC pose significant anesthetic challenges.

Purpose of the Study:

• To describe the haemodynamic changes observed during HITOC.
• To evaluate the anesthetic challenges associated with HITOC.
• To report on the haemodynamic effects of hyperthermic chemotherapy in the thorax.

Main Methods:

• Retrospective case note review of adult patients undergoing CRS with HITOC (2009-2016).
• Intra-operative haemodynamics monitored using an invasive cardiac output (CO) monitor (LIDCOrapid™).
• Recorded intravenous fluids, vasopressor requirements, and urine output (UO).

Main Results:

• Four patients were analyzed, with minimal changes in heart rate, CO, and stroke volume variation (SVV).
• Vasopressor requirements and urine output remained stable during HITOC.
• No significant changes in pH or base excess were observed, indicating haemodynamic stability.

Conclusions:

• Careful monitoring of haemodynamic variables allows for precise titration of fluid therapy.
• This approach can maintain haemodynamic stability during HITOC, a finding not previously described.
• HITOC combined with CRS is feasible with appropriate anaesthetic management.