Anesthesia management of patients undergoing hyperthermic isolated limb perfusion with melphalan for melanoma treatment: An analysis of 17 cases

BMC Anesthesiology (Impact Factor: 1.38). 07/2013; 13(1):15. DOI: 10.1186/1471-2253-13-15
Source: PubMed


Hyperthermic isolated limb perfusion (HILP) is used for patients with intractable or extensive in-transit metastatic melanoma of the limb to deliver high concentrations of cytotoxic agents to the affected limb and offers a treatment option in a disease stage with a poor prognosis when no treatment is given.
In a retrospective chart review of 17 cases, we studied the anesthetic and hemodynamic changes during HILP and its management.
HILP was well tolerated except in one case that is described herein. We present summary data of all cases undergoing upper and lower limb perfusion, discuss our current clinical practice of preoperative, perioperative and intraoperative patient care including the management of HILP circuit.
HILP is a challenging procedure, and requires a team effort including the surgical team, anesthesia care providers, perfusionists and nurses. Intraoperatively, invasive hemodynamic and metabolic monitoring is indispensable to manage significant hemodynamic and metabolic changes due to fluid shifts and release of cytokines.

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    ABSTRACT: Recent advances in cancer therapy have seen increased combinations of different treatment modalities as well as novel approaches that affect anaesthetic care. Increasingly, surgery is being combined with chemotherapy and radiation therapy. Moreover, minimally invasive procedures are gaining popularity and more targeted therapies are being used. These events have created a demand for new anaesthetic techniques from anaesthesiologists in order to provide safe patient care. This article will discuss anaesthetic considerations for proton therapy, hyperthermic intracavitary chemotherapy, limb perfusion, radiosurgery, robotic surgery and intra-operative radiation therapy and high-dose brachytherapy.
    No preview · Article · Dec 2013