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Isolated regional perfusion; anaesthetic technique, monitoring and blood replacement
Abstract:
Isolated regional perfusion for the treatment of malignant melanoma is an accepted method of treatment. No standard of anaesthetic practice has been established for those individuals. Perioperative records of patients undergoing isolated limb perfusion were studied to determine adequate blood replacement. Records were examined and compared for (1) age, (2) ASA physical status, (3) presence of associated disease, (4) anaesthetic technique, (5) the amount of blood and fluid replacement, (6) preoperative haemoglobin (hgb) and haematocrit (hct) and postoperative serial complete blood counts. Fifteen patients were studied (mean age 53 +/- 16 yrs). Mean blood and fluid replacement was: packed red blood cells; 2.28 +/- 0.82 units, 722 +/- 17 ml of 5 per cent albumin, 1747 +/- 21 ml crystalloid. There were twelve Physical Status Class I or II and three Class III patients. All patients received general anaesthesia. There was a statistically significant difference in the preoperative and postoperative values for haemoglobin and haematocrit (p less than 0.01) with no difference between the postoperative and discharge values. Adequate blood replacement was determined by the equation: (Formula: see text) Extensive invasive monitoring is not routinely required for adequate blood replacement or the detection of leaks between the systemic and isolated circulation.
Insights
This study analyzed anesthetic practices for isolated limb perfusion in melanoma patients. Adequate blood replacement can be achieved without extensive invasive monitoring, ensuring patient safety.
Area of Science:
- Anesthesiology
- Surgical Oncology
Background:
- Isolated regional perfusion (IRP) is a recognized treatment for malignant melanoma.
- Anesthetic management standards for IRP are not well-established.
- Understanding perioperative fluid and blood replacement is crucial for patient outcomes.
Purpose of the Study:
- To evaluate anesthetic practices during isolated limb perfusion for melanoma.
- To determine guidelines for adequate blood and fluid replacement during IRP.
- To assess the necessity of invasive monitoring for blood replacement and leak detection.
Main Methods:
- Retrospective review of perioperative records for 15 patients undergoing IRP.
- Analysis of patient demographics (age, ASA status, comorbidities).
- Comparison of anesthetic techniques, blood/fluid replacement volumes, and serial hemoglobin/hematocrit levels.
Main Results:
- Mean patient age was 53 years; most were ASA Class I or II.
- Average replacement included 2.28 units PRBCs, 722 ml albumin, and 1747 ml crystalloid.
- Significant decrease in hemoglobin and hematocrit from pre- to post-operative, with no change at discharge.
Conclusions:
- Standard general anesthesia is suitable for IRP.
- Established formulas can guide adequate blood and fluid replacement.
- Extensive invasive monitoring is not routinely required for IRP, simplifying anesthetic management.