Annals of Surgical Oncology

, Volume 7, Issue 4, pp 296–300 | Cite as

Hemodynamic and Cardiac Function Parameters During Heated Intraoperative Intraperitoneal Chemotherapy Using the Open “Coliseum Technique”

  • Jesus Esquivel
  • Francisco Angulo
  • Rebecca K. Bland
  • Arvil D. Stephens
  • Paul H. Sugarbaker
Original Articles

Abstract

Background: Heated intraoperative intraperitoneal chemotherapy achieves high peritoneal concentrations with limited systemic absorption and has become an important tool in the management of patients with peritoneal carcinomatosis from low-grade malignancies such as pseudomyxoma peritonei and in selected cases of high-grade tumors such as colon adenocarcinoma. When the closed abdomen technique is used, its perioperative toxicity seems to be related to the hemodynamic and cardiac function changes associated with increased body temperature and increased intra-abdominal pressure.

Methods: Hemodynamic and cardiac function variables during heated intraoperative intraperitoneal chemotherapy, using an open abdomen “coliseum technique,” were measured in 15 patients with the use of a noninvasive esophageal Doppler monitor.

Results: The hemodynamic and cardiac function changes were characterized by an increased heart rate, increased cardiac output and decreased systemic vascular resistance associated with an increased body temperature, and decreased effective circulating volume with the urinary output tending to decrease as the therapy progressed.

Conclusion: Heated intraoperative intraperitoneal chemotherapy with the open abdomen coliseum technique induces a hyperdynamic circulatory state with an increased intravenous fluid requirement and avoids changes because of increased intra-abdominal pressure. Hemodynamic and cardiac stability, as documented by normal blood pressure and adequate urinary output, can be achieved by liberal intravenous fluids, titrated to frequent urinary output determination.

Key Words:

Heated intraoperative intraperitoneal chemotherapy—Operative monitoring. 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. 1.
    Sugarbaker PH, Ronnett BM, Archer A, et al. Pseudomyxoma Peritonei Syndrome In: Advances in Surgery, Vol. 30. St. Louis: Mosby-Year Book Inc., 1997:233–80.Google Scholar
  2. 2.
    Sugarbaker PH. Peritonectomy procedures. Ann Surg 1995;221: 29–42.PubMedCrossRefGoogle Scholar
  3. 3.
    Sugarbaker PH, Averbach AM, Jacquet P, et al. A simplified approach to hyperthermic intraoperative intraperitoneal chemotherapy using a self retaining retractor. In: Sugarbaker PH, ed. Peritoneal Carcinomatosis: Principles of Management. Norwell, MA: Kluwer, 1996:415–21.Google Scholar
  4. 4.
    Jacquet P, Averbach AM, Stephens AD, Stuart OA, Chang D, Sugarbaker PH. Heated intraoperative intraperitoneal mitomycin C and early postoperative intraperitoneal 5-fluorouracil: pharmacokinetics studies. Oncology 1998;55:130–8.PubMedGoogle Scholar
  5. 5.
    White SK, Stephens AD, Sugarbaker PH. Hyperthermic intraoperative intraperitoneal chemotherapy: safety considerations. AORN J 1996;63:716–24.PubMedGoogle Scholar
  6. 6.
    Singer M. Esophageal Doppler monitoring of aortic blood flow: beat by beat cardiac output monitoring. Int Anesthesiol Clin 1993; 31:99–125.PubMedGoogle Scholar
  7. 7.
    Kanakoudis F, Petrou A, Michaloudis D, Chortaria G, Konstantinidou A. Anaesthesia for intra-peritoneal perfusion of hyperthermic chemotherapy: haemodynamic changes, oxygen consumption and delivery. Anaesthesia 1996;51:1033–6.PubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2000

Authors and Affiliations

  • Jesus Esquivel
    • 1
  • Francisco Angulo
    • 1
  • Rebecca K. Bland
    • 1
  • Arvil D. Stephens
    • 1
  • Paul H. Sugarbaker
    • 1
    • 2
  1. 1.The Washington Cancer InstituteWashington
  2. 2.The Washington Cancer InstituteWashington

Personalised recommendations