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[O2 utilization during hyperthermic extremity perfusion with rhTNF alpha and melphalan]
J Haier1, P Hohenberger, K Beck
1Virchow-Klinikum, Humboldt-Universität, Berlin.
Langenbecks Archiv Fur Chirurgie
|January 1, 1997
Summary
Isolated limb perfusion (ILP) can cause metabolic changes, increasing oxygen demand and lactate. Monitoring tissue oxygen supply during ILP is crucial to minimize toxicity and prevent complications like lactacidosis.
Area of Science:
- Oncology
- Physiology
- Pharmacology
Context:
- Isolated limb perfusion (ILP) is used to treat limb tumors.
- ILP involves extracorporeal circulation, hyperthermia, and drug administration, potentially causing metabolic disturbances.
- Understanding metabolic changes during ILP is vital for patient safety.
Purpose:
- To investigate the metabolic and hemodynamic effects of ILP with tumor necrosis factor-alpha (TNF) and melphalan.
- To assess oxygen supply and consumption, and lactate levels during and after ILP in patients with melanoma or soft-tissue sarcoma.
Summary:
- Thirty-three patients undergoing ILP were monitored for oxygen saturation, lactate, and cardiac output.
- Oxygen delivery (DO2I) and consumption (VO2I) increased during ILP and post-reperfusion, driven by increased cardiac output.
- Lactate levels rose post-reperfusion, correlating with regional toxicity, suggesting potential oxygen depletion in the limb.
Impact:
- Findings highlight the importance of monitoring tissue oxygenation during ILP to mitigate toxicity.
- Elevated lactate and oxygen utilization post-reperfusion may indicate limb oxygen debt, potentially leading to lactacidosis or rhabdomyolysis.
- Adequate tissue oxygen supply monitoring during ILP is essential for minimizing adverse effects.