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Case Studies | Anaesthesiology | India | Volume 12 Issue 12, December 2023
Anaesthesia for HIPEC Surgery: A Case Report
Geena Mariam George | Mary Thomas [5]
Abstract: Mesothelioma is a malignancy of serosal membranes. Peritoneum is the second most common site of malignant mesothelioma after visceral pleura. The disease presents with diffuse extensive spread throughout the abdominal cavity with rare metastatic spread beyond. This was considered an incurable condition until, Dr Paul Sugarbaker showed that HIPEC surgery (hyperthermic intraperitoneal chemotherapy) improved quality of life and survival of patients. Here, we describe the management of a 33 years old female patient, ASA PS 1 with peritoneal mesothelioma who underwent HIPEC surgery. HIPEC involves exposing the peritoneal surface to a high concentration of heated chemotherapeutic drug to destroy all residual microscopic disease after visceral resection. It consists of 3 phases- the CRS (cytoreductive surgery) phase, HIPEC phase and post HIPEC phase. The anesthesiologist has a crucial position throughout the surgery and post operative period. CRS phase is associated with massive ?uid shift, blood loss and hemodynamic alterations. Prior to HIPEC phase, patient is cooled with ice packs and cold fluids to decrease the risks of hyperthermia. The chemotherapeutic agents (oxaliplatin, cisplatin, mitomycin C, and doxorubicin) are delivered mixed in isotonic saline or dextrose-containing ?uid. These solutions may enter the circulatory system leading to electrolyte imbalances like hyponatremia and hyperglycemia. Patients have to be kept well hydrated during the procedure, as acute kidney injury can occur. Here we attempt to highlight the challenges we faced and the complications that arose both in intraoperative and postoperative period despite the precautions we took.
Keywords: Mesothelioma, HIPEC surgery, peritoneal cancer, anesthesiology, chemotherapeutic agents
Edition: Volume 12 Issue 12, December 2023,
Pages: 1198 - 1201