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Perianesthesia Care of the Oncologic Patient Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal
Insights
Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) requires specialized perianesthesia care due to significant blood loss and high complication rates. This major surgery demands expert management of hemodynamics, pain, and postoperative recovery.
Area of Science:
- Anesthesiology
- Surgical Oncology
Background:
- Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is a complex procedure for advanced abdominal cancers.
- Effective perianesthesia care is crucial for managing the unique challenges associated with this surgery.
Purpose of the Study:
- To analyze the characteristics and outcomes of perianesthesia care for patients undergoing CRS + HIPEC.
- To identify key challenges and areas for improvement in the perioperative management of CRS + HIPEC patients.
Main Methods:
- Retrospective analysis of 189 CRS + HIPEC cases from 2012 to 2018.
- Review of perioperative electronic medical records to assess anesthetic management and patient outcomes.
Main Results:
- The study involved 189 patients with a median age of 57, primarily with appendix or colorectal cancers.
- Anesthesia duration averaged 10.47 hours, with significant blood loss (mean 623 mL) and crystalloid administration (mean 8,377 mL).
- Postoperative complications occurred in 73% of patients, with 29% experiencing major complications (Clavien-Dindo grade III+), often due to gastrointestinal or respiratory issues.
Conclusions:
- CRS + HIPEC presents substantial perianesthesia challenges, including hemodynamic instability, pain management, and a high incidence of postoperative complications.
- Enhanced training and further research are essential for perianesthesia teams to optimize care for CRS + HIPEC patients.
Purpose:
This study was to understand the perianesthesia care for patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC).
Method:
This is a retrospective study.
Design:
The perioperative electronic medical records of 189 CRS + HIPEC surgical cases at a hospital of Western Pennsylvania from 2012 to 2018 were analyzed to study the characteristics of perianesthesia care for CRS + HIPEC surgery.
Findings:
The patients' median age was 57 (range 21-83) years, and 60% were men. The mean anesthesia time was 10.47 ± 2.54 hours. Most tumors were appendix or colorectal in origin, and the mean peritoneal cancer index score was 16.19 ± 8.76. The mean estimated blood loss was 623 ± 582 mL. The mean total intravenous crystalloid administered was 8,377 ± 4,100 mL. Fifty-two patients received packed red blood cells during surgery. Postoperatively, 100% of the patients were transferred to the intensive care unit. A majority (52%) of patients were extubated in the operating room. Median lengths of hospital and intensive care unit stays were 13 and 2 days, respectively. A majority (73%) of patients had 1 or more postoperative complications and 29% of patients experienced major postoperative complications (Clavien-Dindo grade III or higher) during the hospital stay. Prolonged hospitalization was owing to gastrointestinal dysfunctions and respiratory failure related to atelectasis and pleural effusion.
Conclusions:
CRS + HIPEC is a major surgery with numerous challenges to the perianesthesia care team regarding hemodynamic adjustment, pain control, and postoperative complications, which demand training and future studies from the perianesthesia care team.
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