Standard Operating Procedures for Anesthesia Management in Cytoreductive Surgery and Hyperthermic Intraperitoneal...

Area of Science:

• Anesthesiology
• Surgical Oncology
• Peritoneal Malignancy

Background:

• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) are complex procedures for peritoneal tumors.
• While surgical expertise is recognized, the impact of anesthesia management on patient outcomes is less understood.
• Standardized operating procedures (SOPs) in anesthesia may optimize perioperative care.

Purpose of the Study:

• To assess the impact of standardized anesthesia operating procedures (SOPs) on perioperative patient outcomes following CRS/HIPEC.
• To identify key anesthetic management factors influencing morbidity and mortality in CRS/HIPEC patients.

Main Methods:

• A retrospective analysis of 112 CRS/HIPEC procedures performed between 2009 and 2015.
• Procedures were divided into pre-SOP (n=57) and post-SOP (n=55) groups.
• SOPs standardized management of fluids, albumin, hemostasis, and body temperature.

Main Results:

• Introduction of SOPs led to reduced colloid and diuretic use, increased albumin and coagulation factor substitution.
• Patients in the post-SOP group had higher end-operative temperatures and increased extubation in the operating room.
• Major complications and reoperations significantly decreased post-SOP implementation.
• Excessive colloid administration (>2000 mL) was linked to increased morbidity, while albumin substitution correlated with better outcomes.

Conclusions:

• Standardized anesthesia operating procedures (SOPs) significantly improve perioperative outcomes in CRS/HIPEC.
• Colloid administration management is an independent prognostic factor for patient outcomes.
• This underscores the critical role of anesthesiologists in optimizing CRS/HIPEC patient care and necessitates specialized training.