Safety constiderations in the use of intraoperative intraperitoneal chemotherapy

Abstract

The drugs frequently used intraoperatively within the abdomen and pelvis at the present time are cisplatin and mitomycin C. Both of these drugs are used at 43°C for 1–2 hours at maximal systemic doses of the drugs. The major toxicity of these drugs is renal impairment, which can be minimized by maintenance of a brisk diuresis, thus protecting all patients with normal renal function. In our experience with these renal toxic drugs, the safest place for their administration is the operating room. Monitoring the urine output at 15 minute intervals should eliminate drug pooling in the kidney tubules and consequent renal tubular insult. Large volumes of fluid can be safely used without fear of pulmonary edema because patients are endotracheally intubated and on positive pressure ventilation. Renal dopamine at 3μg/kg/min is regularly used in order to promote a diuresis. If urine output falls below 100 ml every 15 minutes, then a diuretic is given as an intravenous bolus. Generally furosemide administered at 10–20mg will result in more than a liter of urine in only a few minutes time.