Abstract
Isolated regional perfusion for the treatment of malignant melanoma is an accepted method of treatment. No standard of anaesthetic practice has been established for those individuals. Perioperative records of patients undergoing isolated limb perfusion were studied to determine adequate blood replacement. Records were examined and compared for (1) age, (2) ASA physical status, (3 ) presence of associated disease, (4) anaesthetic technique, (5) the amount of blood and fluid replacement, (6) preoperative haemoglobin (hgb) and haematocrit (hct) and postoperative serial complete blood counts. Fifteen patients were studied (mean age 53 ± 16 yrs). Mean blood and fluid replacement was: packed red blood cells; 2.28 ± 0.82 units, 722 ± 17 ml of 5 per cent albumin, 1747 ± 21 ml crystalloid. There were twelve Physical Status Class I or 11 and three Class 111 patients. Ail patients received general anaesthesia. There was a statistically significant difference in the preoperative and postoperative values for haemoglobin and haematocrit (p < 0.01) with no difference between the postoperative and discharge values. Adequate blood replacement was determined by the equation:
Extensive invasive monitoring is not routinely required for adequate blood replacement or the detection of leaks between the systemic and isolated circulation.
Résumé
La perfusion régionale isolée de substance cytoto.xique est un traitement reconmt du métanome malin. II n’exisie pas de normes auxquelles se référer pour I’anesthésie de ces individus. Nous avons done étudié les dossiers péri-opératoires de 15 patients nous attachant en parti culier à déterminer la précision du remplacement sanguin. Nous avons relevé: (I) I’age, (2) état physique selon l’échelle ASA, (3) la presence de maladie concomi-tante, (4) la technique anesthésique, (5) la quanlité de sang et de liquide infusé, (6) hémoglobine pré-opératoire (hgbj et hématocrite (ha) et la formule sanguine sériée en post-opératoire. Les valeurs moyennes de remplacement de sang et de liquide ont été: culots globulaires: 2,28 ± 0.82 unités (562 ml), albumine 722 ± 17 ml, crystal-loides: 1747 ± 21 ml. Dans cette série on retrouvait 12 malades classe I ou 11 et trois malades en classe Hi. Tous ont reçu une anesthésie générate. On a retrouvé une différence statistiquement significative entre les valeurs pré: et post-opératoires pour hémoglobine et l’ hématocrite (p <0,01) mais aucune différence entre la valeur post-opératoire et la valeur au congé du malade.
Léquation suivante permet d’assurer un remplacement liquidien sufjisamment précis :
Il n’est pas nécessaire de recourir à un monitoring invasif impressionnant pour la perte sanguine ou la détection defuite entre la circulation systémique et la circulation isolée.
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Goldberg, M.E., Rosenblum, H.M., Seltzer, J.L. et al. Isolated regional perfusion; anaesthetic technique, monitoring and blood replacement. Can Anaesth Soc J 31, 552–558 (1984). https://doi.org/10.1007/BF03009542
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DOI: https://doi.org/10.1007/BF03009542