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Revista Española de Anestesiología y Reanimación (English Edition)
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Vol. 67. Issue 1.
Pages 15-19 (January 2020)
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Vol. 67. Issue 1.
Pages 15-19 (January 2020)
Brief report
Perioperative anesthetic management of patients with malignant pleural mesothelioma undergoing cytoreductive surgery and intraoperative chemotherapy
Manejo anestésico perioperatorio de pacientes con mesotelioma maligno pleural intervenidos mediante cirugía citorreductora y quimioterapia intratorácica
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J.M. Gómez Tarradasa,
Corresponding author
jgomezt@clinic.cat

Corresponding author.
, G. Pujol Fontrodonaa, M. López-Baamondea, D. Sánchezb, M.J. Jiméneza, R. Navarro-Ripolla
a Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clinic de Barcelona, Barcelona, Spain
b Servicio de Cirugía Torácica, Hospital Clinic de Barcelona, Barcelona, Spain
Article information
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Table 1. Patient characteristics.
Table 2. Intraoperative and postoperative data.
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Abstract
Introduction

Cytoreductive surgery with hyperthermic intraoperative chemotherapy (HITHOC) is a therapeutic option for treatment of malignant pleural mesothelioma. Anaesthetic management might be challenging.

Patients and methods

A descriptive analysis of a case series is presented. Seven patients with malignant pleural mesothelioma diagnostic undergoing HITHOC surgery were studied. Combined general and epidural anaesthesia were administered. An intensive haemodynamic monitorization was implemented. Data regarding perioperative course was analyzed.

Results

Between May 2015 and October 2018 7 patients underwent HITHOC procedure. Blood transfusions were administered in all patients, and 5 of the 7 patients required vasoactive drug administration. Extubation at the end of the procedure was able in 6 of the 7 patients. The median length of stay in ICU was 4 days, and 29 days for the whole hospitalary stay. No significant postoperative pain was observed.

Conclusions

HITHOC surgery is a complex procedure in which several haemodynamic changes occur. An intensive intraoperative monitorization was useful for controlling complications.

Keywords:
Thoracic surgery
Anaesthesia
Mesothelioma
Pleura
Chemotherapy
Induced hyperthermia
Analgesia
Surgical oncology
Intravenous anaesthesia
General anaesthesia
Perioperative care
Resumen
Introducción

La cirugía citorreductora asociada a quimioterapia hipertérmica intraoperatoria (HITHOC) es una alternativa terapéutica del mesotelioma maligno pleural. Su manejo supone un reto para el anestesiólogo.

Material y métodos

Se elabora un análisis descriptivo de una serie de casos de pacientes con diagnóstico de mesotelioma maligno pleural intervenidos de HITHOC. El manejo anestésico se realizó con anestesia general asociada a epidural y una extensa monitorización hemodinámica. Se analizaron datos del periodo perioperatorio.

Resultados

Siete pacientes fueron intervenidos entre mayo de 2015 y octubre de 2018. Durante el intraoperatorio, todos requirieron transfusión de hemoderivados y, 5de ellos, perfusión de fármacos vasoactivos. En 6pacientes se logró la extubación al finalizar la intervención. La mediana de estancia en cuidados intensivos y hospitalaria fueron 4 y 29 días, respectivamente. No se observó dolor postoperatorio significativo.

Conclusión

La cirugía HITHOC es un procedimiento agresivo con importantes cambios hemodinámicos. Una monitorización intensiva fue útil para tratar las complicaciones.

Palabras clave:
Cirugía torácica
Anestesia
Mesotelioma
Quimioterapia
Hipertermia inducida
Analgesia
Cirugía oncológica
Anestesia intravenosa
Anestesia general
Cuidados perioperatorios

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