Hyperthermic intraperitoneal chemotherapy surgery - Revision history

Chris.Rishel: Added GI consideration, minor formatting fixes

2022-11-29T15:07:00Z

Added GI consideration, minor formatting fixes

← Older revision		Revision as of 08:07, 29 November 2022
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	\|-		\|-
	\|Gastrointestinal		\|Gastrointestinal
	\|		\|Hypoalbuminemia associated with a higher major morbidity<ref>{{Cite journal\|last=Seretis\|first=Charalampos\|last2=Gill\|first2=Jagjit\|last3=Malik\|first3=Adnan\|last4=Elhassan\|first4=Ali Mohamed\|last5=Shariff\|first5=Umar\|last6=Youssef\|first6=Haney\|date=2020-12\|title=Low Preoperative Serum Albumin Levels Are Associated With Impaired Outcome After Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Peritoneal Surface Malignancies\|url=https://pubmed.ncbi.nlm.nih.gov/33447310/\|journal=Journal of Clinical Medicine Research\|volume=12\|issue=12\|pages=773–779\|doi=10.14740/jocmr4362\|issn=1918-3003\|pmc=7781284\|pmid=33447310}}</ref>
	\|-		\|-
	\|Hematologic		\|Hematologic
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	* CMP (particularly renal function and electrolytes)		* CMP (particularly renal function and electrolytes)
	* CBC (identify and correct anemia) - If Hg > 9 g/dL, consider prehabilitation		* CBC (identify and correct anemia)
			**If Hg > 9 g/dL, consider prehabilitation
	* Consider pre-albumin to evaluate nutrition status		* Consider pre-albumin to evaluate nutrition status

Chris.Rishel: Removed GI consideration for demonstrative purposes, will re-add tomorrow

2022-11-28T18:54:51Z

Removed GI consideration for demonstrative purposes, will re-add tomorrow

← Older revision		Revision as of 11:54, 28 November 2022
Line 97:		Line 97:
	\|-		\|-
	\|Gastrointestinal		\|Gastrointestinal
	\|Hypoalbuminemia associated with higher major mobidity<ref>{{Cite journal\|last=Seretis\|first=Charalampos\|last2=Gill\|first2=Jagjit\|last3=Malik\|first3=Adnan\|last4=Elhassan\|first4=Ali Mohamed\|last5=Shariff\|first5=Umar\|last6=Youssef\|first6=Haney\|date=2020\|title=Low Preoperative Serum Albumin Levels Are Associated With Impaired Outcome After Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Peritoneal Surface Malignancies\|url=https://pubmed.ncbi.nlm.nih.gov/33447310\|journal=Journal of Clinical Medicine Research\|volume=12\|issue=12\|pages=773–779\|doi=10.14740/jocmr4362\|issn=1918-3003\|pmc=7781284\|pmid=33447310\|via=}}</ref>		\|
	\|-		\|-
	\|Hematologic		\|Hematologic

UNCRobIsaak: Made a few minor edits to existing pages including one new citation.

2022-07-06T12:26:48Z

Made a few minor edits to existing pages including one new citation.

← Older revision		Revision as of 05:26, 6 July 2022
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	}}'''Hyperthermic intraperitoneal chemotherapy surgery (HIPEC)''' and '''cytoreductive surgery''' is a combined procedure utilized to treat peritoneal surface cancers.<ref name=":0">{{Cite journal\|last=Webb\|first=Christopher Allen-John\|last2=Weyker\|first2=Paul David\|last3=Moitra\|first3=Vivek K.\|last4=Raker\|first4=Richard K.\|date=2013\|title=An overview of cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion for the anesthesiologist\|url=https://pubmed.ncbi.nlm.nih.gov/23460568\|journal=Anesthesia and Analgesia\|volume=116\|issue=4\|pages=924–931\|doi=10.1213/ANE.0b013e3182860fff\|issn=1526-7598\|pmid=23460568\|via=}}</ref> These cancers include secondary peritoneal carcinomatosis, pseudomyxoma peritonei and primary peritoneal tumors.<ref name=":0" /><ref>{{Cite journal\|last=Macrì\|first=Antonio\|date=2010-01-15\|title=New approach to peritoneal surface malignancies\|url=https://pubmed.ncbi.nlm.nih.gov/21160811\|journal=World Journal of Gastrointestinal Oncology\|volume=2\|issue=1\|pages=9–11\|doi=10.4251/wjgo.v2.i1.9\|issn=1948-5204\|pmc=2999159\|pmid=21160811}}</ref> Cytoreductive surgery involves debulking the majority of tumors until the remainder are small enough to ensure adequate efficacy with HIPEC.		}}'''Hyperthermic intraperitoneal chemotherapy surgery (HIPEC)''' and '''cytoreductive surgery''' is a combined procedure utilized to treat peritoneal surface cancers.<ref name=":0">{{Cite journal\|last=Webb\|first=Christopher Allen-John\|last2=Weyker\|first2=Paul David\|last3=Moitra\|first3=Vivek K.\|last4=Raker\|first4=Richard K.\|date=2013\|title=An overview of cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion for the anesthesiologist\|url=https://pubmed.ncbi.nlm.nih.gov/23460568\|journal=Anesthesia and Analgesia\|volume=116\|issue=4\|pages=924–931\|doi=10.1213/ANE.0b013e3182860fff\|issn=1526-7598\|pmid=23460568\|via=}}</ref> These cancers include secondary peritoneal carcinomatosis, pseudomyxoma peritonei and primary peritoneal tumors.<ref name=":0" /><ref>{{Cite journal\|last=Macrì\|first=Antonio\|date=2010-01-15\|title=New approach to peritoneal surface malignancies\|url=https://pubmed.ncbi.nlm.nih.gov/21160811\|journal=World Journal of Gastrointestinal Oncology\|volume=2\|issue=1\|pages=9–11\|doi=10.4251/wjgo.v2.i1.9\|issn=1948-5204\|pmc=2999159\|pmid=21160811}}</ref> Cytoreductive surgery involves debulking the majority of tumors until the remainder are small enough to ensure adequate efficacy with HIPEC.

	HIPEC involves infusing heated cytotoxic chemotherapeutic drugs directly into the surgical site in order to effectively penetrate involved cancer while limiting exposure to normal tissue and decrease systemic uptake.<ref name=":0" /><ref name=":1">{{Cite journal\|last=Schmidt\|first=C.\|last2=Moritz\|first2=S.\|last3=Rath\|first3=S.\|last4=Grossmann\|first4=E.\|last5=Wiesenack\|first5=C.\|last6=Piso\|first6=P.\|last7=Graf\|first7=B. M.\|last8=Bucher\|first8=M.\|date=2009-09-15\|title=Perioperative management of patients with cytoreductive surgery for peritoneal carcinomatosis\|url=https://pubmed.ncbi.nlm.nih.gov/19697426\|journal=Journal of Surgical Oncology\|volume=100\|issue=4\|pages=297–301\|doi=10.1002/jso.21322\|issn=1096-9098\|pmid=19697426}}</ref><ref>{{Cite journal\|last=Al-Shammaa\|first=Hassan-Alaa-Hammed\|last2=Li\|first2=Yan\|last3=Yonemura\|first3=Yutaka\|date=2008-02-28\|title=Current status and future strategies of cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis\|url=https://pubmed.ncbi.nlm.nih.gov/18300340\|journal=World Journal of Gastroenterology\|volume=14\|issue=8\|pages=1159–1166\|doi=10.3748/wjg.14.1159\|issn=1007-9327\|pmc=2690662\|pmid=18300340}}</ref> This may be performed in a closed abdomen via perfusion circuit or an open abdomen +/- cavity expanders.<ref>{{Cite journal\|last=Witkamp\|first=A. J.\|last2=de Bree\|first2=E.\|last3=Van Goethem\|first3=R.\|last4=Zoetmulder\|first4=F. A.\|date=2001\|title=Rationale and techniques of intra-operative hyperthermic intraperitoneal chemotherapy\|url=https://pubmed.ncbi.nlm.nih.gov/11908929\|journal=Cancer Treatment Reviews\|volume=27\|issue=6\|pages=365–374\|doi=10.1053/ctrv.2001.0232\|issn=0305-7372\|pmid=11908929\|via=}}</ref> Compared to a closed abdomen approach, an open abdomen technique may reduce intraabdominal pressures and prevent reuse of the cytotoxic solution. However, the closed abdomen technique reduces risk of exposure of the medications to the OR staff.		HIPEC involves infusing heated cytotoxic chemotherapeutic drugs directly into the surgical site in order to effectively penetrate involved cancer while limiting exposure to normal tissue and decrease systemic uptake.<ref name=":0" /><ref name=":1">{{Cite journal\|last=Schmidt\|first=C.\|last2=Moritz\|first2=S.\|last3=Rath\|first3=S.\|last4=Grossmann\|first4=E.\|last5=Wiesenack\|first5=C.\|last6=Piso\|first6=P.\|last7=Graf\|first7=B. M.\|last8=Bucher\|first8=M.\|date=2009-09-15\|title=Perioperative management of patients with cytoreductive surgery for peritoneal carcinomatosis\|url=https://pubmed.ncbi.nlm.nih.gov/19697426\|journal=Journal of Surgical Oncology\|volume=100\|issue=4\|pages=297–301\|doi=10.1002/jso.21322\|issn=1096-9098\|pmid=19697426}}</ref><ref>{{Cite journal\|last=Al-Shammaa\|first=Hassan-Alaa-Hammed\|last2=Li\|first2=Yan\|last3=Yonemura\|first3=Yutaka\|date=2008-02-28\|title=Current status and future strategies of cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis\|url=https://pubmed.ncbi.nlm.nih.gov/18300340\|journal=World Journal of Gastroenterology\|volume=14\|issue=8\|pages=1159–1166\|doi=10.3748/wjg.14.1159\|issn=1007-9327\|pmc=2690662\|pmid=18300340}}</ref> This may be performed in a closed abdomen via perfusion circuit or an open abdomen +/- cavity expanders (sometimes referred to as the Coliseum technique<ref>{{Cite journal\|last=Rodríguez Silva\|first=Cristina\|last2=Moreno Ruiz\|first2=Francisco Javier\|last3=Bellido Estévez\|first3=Inmaculada\|last4=Carrasco Campos\|first4=Joaquin\|last5=Titos García\|first5=Alberto\|last6=Ruiz López\|first6=Manuel\|last7=González Poveda\|first7=Ivan\|last8=Toval Mata\|first8=Jose Antonio\|last9=Mera Velasco\|first9=Santiago\|last10=Santoyo Santoyo\|first10=Julio\|date=2017-02-21\|title=Are there intra-operative hemodynamic differences between the Coliseum and closed HIPEC techniques in the treatment of peritoneal metastasis? A retrospective cohort study\|url=https://pubmed.ncbi.nlm.nih.gov/28222738\|journal=World Journal of Surgical Oncology\|volume=15\|issue=1\|pages=51\|doi=10.1186/s12957-017-1119-2\|issn=1477-7819\|pmc=5320712\|pmid=28222738}}</ref>).<ref>{{Cite journal\|last=Witkamp\|first=A. J.\|last2=de Bree\|first2=E.\|last3=Van Goethem\|first3=R.\|last4=Zoetmulder\|first4=F. A.\|date=2001\|title=Rationale and techniques of intra-operative hyperthermic intraperitoneal chemotherapy\|url=https://pubmed.ncbi.nlm.nih.gov/11908929\|journal=Cancer Treatment Reviews\|volume=27\|issue=6\|pages=365–374\|doi=10.1053/ctrv.2001.0232\|issn=0305-7372\|pmid=11908929\|via=}}</ref> Compared to a closed abdomen approach, an open abdomen technique may reduce intraabdominal pressures and prevent reuse of the cytotoxic solution. However, the closed abdomen technique reduces risk of exposure of the medications to the OR staff.

	Important perioperative considerations include temperature management, cardiovascular management, intra-abdominal pressures, metabolic derangements (depending on carrier solution of chemotherapeutic agent), potential chemotherapeutic toxicities (see table below), coagulopathy, fluid/renal management and pain management.<ref name=":0" /><ref name=":1" />		Important perioperative considerations include temperature management, cardiovascular management, intra-abdominal pressures, metabolic derangements (depending on carrier solution of chemotherapeutic agent), potential chemotherapeutic toxicities (see table below), coagulopathy, fluid/renal management and pain management.<ref name=":0" /><ref name=":1" />

	~~Intraoperatively~~, OR staff may be exposed to cytotoxic agents due to high concentrations of chemotherapeutic medications, long case duration, and smoke and or mechanical exposure. Pregnant or those actively planning for pregnancy, those with a history of congenital malformations or abortions should carefully consider participation in HIPEC cases. Safety precautions including high-power filtration masks, eye protection, gloves, and standard universal precautions should always be heeded.<ref>{{Cite journal\|last=González-Moreno\|first=Santiago\|last2=González-Bayón\|first2=Luis\|last3=Ortega-Pérez\|first3=Gloria\|date=2012\|title=Hyperthermic intraperitoneal chemotherapy: methodology and safety considerations\|url=https://pubmed.ncbi.nlm.nih.gov/23021715\|journal=Surgical Oncology Clinics of North America\|volume=21\|issue=4\|pages=543–557\|doi=10.1016/j.soc.2012.07.001\|issn=1558-5042\|pmid=23021715\|via=}}</ref>		Although HIPEC surgery is generally safe to participate in as an anesthesia provider, intraoperative OR staff may be exposed to cytotoxic agents due to high concentrations of chemotherapeutic medications, long case duration, and smoke and or mechanical exposure. Pregnant or those actively planning for pregnancy, those with a history of congenital malformations or abortions should carefully consider participation in HIPEC cases. Safety precautions including high-power filtration masks, eye protection, gloves, and standard universal precautions should always be heeded.<ref>{{Cite journal\|last=González-Moreno\|first=Santiago\|last2=González-Bayón\|first2=Luis\|last3=Ortega-Pérez\|first3=Gloria\|date=2012\|title=Hyperthermic intraperitoneal chemotherapy: methodology and safety considerations\|url=https://pubmed.ncbi.nlm.nih.gov/23021715\|journal=Surgical Oncology Clinics of North America\|volume=21\|issue=4\|pages=543–557\|doi=10.1016/j.soc.2012.07.001\|issn=1558-5042\|pmid=23021715\|via=}}</ref>

	== Preoperative management ==		== Preoperative management ==
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	* Central line vs. 2 large bore IVs		* Central line vs. 2 large bore IVs
	* ± Cardiac output monitor (i.e. Flowtrack)		* ± Cardiac output monitor (i.e. Flowtrack)
	* NG tube		* NG or OG tube
	* Vasopressor drips		* Vasopressor drips
	**Norepinephrine		**Norepinephrine
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	=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===

	* Epidural or paravertebral blocks (if epidural is contraindicated)		* Epidural or paravertebral blocks (if epidural is contraindicated).
			*Erector Spinae block could potentially be used (minimal data at this time; only case reports).

	== Intraoperative management ==		== Intraoperative management ==
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	* Multiple large-bore PIVs (for active fluid resuscitation)		* Multiple large-bore PIVs (for active fluid resuscitation)
	* ± Rapid infusion catheter		* ± Rapid infusion catheter (RIC)
	* Arterial line		* Arterial line
	* ± Central venous catheter		* ± Central venous catheter (8 Fr double-lumen, 8.5 Fr single-lumen Cordis, or 9 Fr double-lumen MAC Cordis)

	=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===		=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===

Chris.Little at 18:35, 25 May 2022

2022-05-25T18:35:08Z

← Older revision		Revision as of 11:35, 25 May 2022
Line 25:		Line 25:
	}}'''Hyperthermic intraperitoneal chemotherapy surgery (HIPEC)''' and '''cytoreductive surgery''' is a combined procedure utilized to treat peritoneal surface cancers.<ref name=":0">{{Cite journal\|last=Webb\|first=Christopher Allen-John\|last2=Weyker\|first2=Paul David\|last3=Moitra\|first3=Vivek K.\|last4=Raker\|first4=Richard K.\|date=2013\|title=An overview of cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion for the anesthesiologist\|url=https://pubmed.ncbi.nlm.nih.gov/23460568\|journal=Anesthesia and Analgesia\|volume=116\|issue=4\|pages=924–931\|doi=10.1213/ANE.0b013e3182860fff\|issn=1526-7598\|pmid=23460568\|via=}}</ref> These cancers include secondary peritoneal carcinomatosis, pseudomyxoma peritonei and primary peritoneal tumors.<ref name=":0" /><ref>{{Cite journal\|last=Macrì\|first=Antonio\|date=2010-01-15\|title=New approach to peritoneal surface malignancies\|url=https://pubmed.ncbi.nlm.nih.gov/21160811\|journal=World Journal of Gastrointestinal Oncology\|volume=2\|issue=1\|pages=9–11\|doi=10.4251/wjgo.v2.i1.9\|issn=1948-5204\|pmc=2999159\|pmid=21160811}}</ref> Cytoreductive surgery involves debulking the majority of tumors until the remainder are small enough to ensure adequate efficacy with HIPEC.		}}'''Hyperthermic intraperitoneal chemotherapy surgery (HIPEC)''' and '''cytoreductive surgery''' is a combined procedure utilized to treat peritoneal surface cancers.<ref name=":0">{{Cite journal\|last=Webb\|first=Christopher Allen-John\|last2=Weyker\|first2=Paul David\|last3=Moitra\|first3=Vivek K.\|last4=Raker\|first4=Richard K.\|date=2013\|title=An overview of cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion for the anesthesiologist\|url=https://pubmed.ncbi.nlm.nih.gov/23460568\|journal=Anesthesia and Analgesia\|volume=116\|issue=4\|pages=924–931\|doi=10.1213/ANE.0b013e3182860fff\|issn=1526-7598\|pmid=23460568\|via=}}</ref> These cancers include secondary peritoneal carcinomatosis, pseudomyxoma peritonei and primary peritoneal tumors.<ref name=":0" /><ref>{{Cite journal\|last=Macrì\|first=Antonio\|date=2010-01-15\|title=New approach to peritoneal surface malignancies\|url=https://pubmed.ncbi.nlm.nih.gov/21160811\|journal=World Journal of Gastrointestinal Oncology\|volume=2\|issue=1\|pages=9–11\|doi=10.4251/wjgo.v2.i1.9\|issn=1948-5204\|pmc=2999159\|pmid=21160811}}</ref> Cytoreductive surgery involves debulking the majority of tumors until the remainder are small enough to ensure adequate efficacy with HIPEC.

	HIPEC involves infusing heated cytotoxic chemotherapeutic drugs directly into the surgical site in order to effectively penetrate involved cancer while limiting exposure to normal tissue and decrease systemic uptake.<ref name=":0" /><ref name=":1">{{Cite journal\|last=Schmidt\|first=C.\|last2=Moritz\|first2=S.\|last3=Rath\|first3=S.\|last4=Grossmann\|first4=E.\|last5=Wiesenack\|first5=C.\|last6=Piso\|first6=P.\|last7=Graf\|first7=B. M.\|last8=Bucher\|first8=M.\|date=2009-09-15\|title=Perioperative management of patients with cytoreductive surgery for peritoneal carcinomatosis\|url=https://pubmed.ncbi.nlm.nih.gov/19697426\|journal=Journal of Surgical Oncology\|volume=100\|issue=4\|pages=297–301\|doi=10.1002/jso.21322\|issn=1096-9098\|pmid=19697426}}</ref><ref>{{Cite journal\|last=Al-Shammaa\|first=Hassan-Alaa-Hammed\|last2=Li\|first2=Yan\|last3=Yonemura\|first3=Yutaka\|date=2008-02-28\|title=Current status and future strategies of cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis\|url=https://pubmed.ncbi.nlm.nih.gov/18300340\|journal=World Journal of Gastroenterology\|volume=14\|issue=8\|pages=1159–1166\|doi=10.3748/wjg.14.1159\|issn=1007-9327\|pmc=2690662\|pmid=18300340}}</ref> This may be performed in a closed abdomen via perfusion circuit or an open abdomen +/- cavity expanders.<ref>{{Cite journal\|last=Witkamp\|first=A. J.\|last2=de Bree\|first2=E.\|last3=Van Goethem\|first3=R.\|last4=Zoetmulder\|first4=F. A.\|date=2001\|title=Rationale and techniques of intra-operative hyperthermic intraperitoneal chemotherapy\|url=https://pubmed.ncbi.nlm.nih.gov/11908929\|journal=Cancer Treatment Reviews\|volume=27\|issue=6\|pages=365–374\|doi=10.1053/ctrv.2001.0232\|issn=0305-7372\|pmid=11908929\|via=}}</ref> An open abdomen technique may reduce ~~increased~~ intraabdominal pressures and prevent reuse of the cytotoxic solution. However, the closed abdomen technique reduces risk of exposure of the medications to the OR staff.		HIPEC involves infusing heated cytotoxic chemotherapeutic drugs directly into the surgical site in order to effectively penetrate involved cancer while limiting exposure to normal tissue and decrease systemic uptake.<ref name=":0" /><ref name=":1">{{Cite journal\|last=Schmidt\|first=C.\|last2=Moritz\|first2=S.\|last3=Rath\|first3=S.\|last4=Grossmann\|first4=E.\|last5=Wiesenack\|first5=C.\|last6=Piso\|first6=P.\|last7=Graf\|first7=B. M.\|last8=Bucher\|first8=M.\|date=2009-09-15\|title=Perioperative management of patients with cytoreductive surgery for peritoneal carcinomatosis\|url=https://pubmed.ncbi.nlm.nih.gov/19697426\|journal=Journal of Surgical Oncology\|volume=100\|issue=4\|pages=297–301\|doi=10.1002/jso.21322\|issn=1096-9098\|pmid=19697426}}</ref><ref>{{Cite journal\|last=Al-Shammaa\|first=Hassan-Alaa-Hammed\|last2=Li\|first2=Yan\|last3=Yonemura\|first3=Yutaka\|date=2008-02-28\|title=Current status and future strategies of cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis\|url=https://pubmed.ncbi.nlm.nih.gov/18300340\|journal=World Journal of Gastroenterology\|volume=14\|issue=8\|pages=1159–1166\|doi=10.3748/wjg.14.1159\|issn=1007-9327\|pmc=2690662\|pmid=18300340}}</ref> This may be performed in a closed abdomen via perfusion circuit or an open abdomen +/- cavity expanders.<ref>{{Cite journal\|last=Witkamp\|first=A. J.\|last2=de Bree\|first2=E.\|last3=Van Goethem\|first3=R.\|last4=Zoetmulder\|first4=F. A.\|date=2001\|title=Rationale and techniques of intra-operative hyperthermic intraperitoneal chemotherapy\|url=https://pubmed.ncbi.nlm.nih.gov/11908929\|journal=Cancer Treatment Reviews\|volume=27\|issue=6\|pages=365–374\|doi=10.1053/ctrv.2001.0232\|issn=0305-7372\|pmid=11908929\|via=}}</ref> Compared to a closed abdomen approach, an open abdomen technique may reduce intraabdominal pressures and prevent reuse of the cytotoxic solution. However, the closed abdomen technique reduces risk of exposure of the medications to the OR staff.

	Important perioperative considerations include temperature management, cardiovascular management, intra-abdominal pressures, metabolic derangements (depending on carrier solution of chemotherapeutic agent), potential toxicities (see table below), coagulopathy, fluid/renal management and pain management.<ref name=":0" /><ref name=":1" />		Important perioperative considerations include temperature management, cardiovascular management, intra-abdominal pressures, metabolic derangements (depending on carrier solution of chemotherapeutic agent), potential chemotherapeutic toxicities (see table below), coagulopathy, fluid/renal management and pain management.<ref name=":0" /><ref name=":1" />

	Intraoperatively, OR staff may be exposed to cytotoxic agents due to high concentrations of chemotherapeutic medications, long case duration, and smoke and or mechanical exposure. Pregnant or those actively planning for pregnancy, those with a history of congenital malformations or abortions should carefully consider participation in HIPEC cases. Safety precautions including high-power filtration masks, eye protection, gloves, and standard universal precautions should always be heeded.<ref>{{Cite journal\|last=González-Moreno\|first=Santiago\|last2=González-Bayón\|first2=Luis\|last3=Ortega-Pérez\|first3=Gloria\|date=2012\|title=Hyperthermic intraperitoneal chemotherapy: methodology and safety considerations\|url=https://pubmed.ncbi.nlm.nih.gov/23021715\|journal=Surgical Oncology Clinics of North America\|volume=21\|issue=4\|pages=543–557\|doi=10.1016/j.soc.2012.07.001\|issn=1558-5042\|pmid=23021715\|via=}}</ref>		Intraoperatively, OR staff may be exposed to cytotoxic agents due to high concentrations of chemotherapeutic medications, long case duration, and smoke and or mechanical exposure. Pregnant or those actively planning for pregnancy, those with a history of congenital malformations or abortions should carefully consider participation in HIPEC cases. Safety precautions including high-power filtration masks, eye protection, gloves, and standard universal precautions should always be heeded.<ref>{{Cite journal\|last=González-Moreno\|first=Santiago\|last2=González-Bayón\|first2=Luis\|last3=Ortega-Pérez\|first3=Gloria\|date=2012\|title=Hyperthermic intraperitoneal chemotherapy: methodology and safety considerations\|url=https://pubmed.ncbi.nlm.nih.gov/23021715\|journal=Surgical Oncology Clinics of North America\|volume=21\|issue=4\|pages=543–557\|doi=10.1016/j.soc.2012.07.001\|issn=1558-5042\|pmid=23021715\|via=}}</ref>

Chris.Little: Added several points to intraoperative care

2022-05-25T18:08:12Z

Added several points to intraoperative care

← Older revision		Revision as of 11:08, 25 May 2022
Line 9:		Line 9:
	5-lead ECG		5-lead ECG
	ABP		ABP
	~~CVP~~
	\| considerations_preoperative = Baseline renal function		\| considerations_preoperative = Baseline renal function
	Electrolyte status		Electrolyte status
Line 121:		Line 120:

	* CMP (particularly renal function and electrolytes)		* CMP (particularly renal function and electrolytes)
	* CBC (identify and correct anemia)		* CBC (identify and correct anemia) - If Hg > 9 g/dL, consider prehabilitation
	* Consider pre-albumin to evaluate nutrition status		* Consider pre-albumin to evaluate nutrition status

Line 128:		Line 127:
	* Fluid warmer		* Fluid warmer
	* Arterial line setup		* Arterial line setup
	* ± Central line		* Central line vs. 2 large bore IVs
	* ± Cardiac output monitor (i.e. Flowtrack)		* ± Cardiac output monitor (i.e. Flowtrack)
	* NG tube		* NG tube
	* Vasopressor drips		* Vasopressor drips
			**Norepinephrine
			**Vasopressin
			**Phenylephrine
	* Blood products		* Blood products
			**2 units pRBCs

	=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===		=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
Line 155:		Line 158:

	* General anesthesia with ETT		* General anesthesia with ETT
			*No special precautions
			*Paralysis preferred

	=== Surgical Timeout Communication ===		=== Surgical Timeout Communication ===
Line 174:		Line 179:

	=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===		=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===

			===== <u>Pre-cytoreductive phase</u> =====

			* Check baseline electrolytes
			* Fluid resuscitation to maintain euvolemia: consider arterial line and cardiac output monitoring to guide fluid resuscitation and avoid over-resuscitation

	===== <u>Cytoreductive Phase</u> =====		===== <u>Cytoreductive Phase</u> =====

	* Fluid resuscitation to maintain euvolemia: consider to utilize arterial line and cardiac output monitoring to guide fluid resuscitation and avoid over-resuscitation
	* Check ABG and base deficit q1hour		* Check ABG and base deficit q1hour
	* Check coagulation status q4 hours		* Check coagulation status q4 hours
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	* Consider albumin administration for intravascular fluids		* Consider albumin administration for intravascular fluids
	* Maintain normothermia to mild hypothermia (target temp 35-36.5 °C)		* Maintain normothermia to mild hypothermia (target temp 35-36.5 °C)
	* Monitor urine output and evaluate volume status. If UOP less than 0.5 mL/kg/hr - Consider vasopressin or norepinephrine to maintain MAP if patient is hypotensive but not hypovolemic		* Monitor urine output and evaluate volume status. If UOP less than 0.5 mL/kg/hr - Consider vasopressin or norepinephrine to maintain MAP if patient is hypotensive but not hypovolemic
	* Obtain pre-HIPEC chemistries (Na+, K+, Mg2+, Ca2+)<ref>{{Cite journal\|last=Rothfield\|first=Kenneth P.\|last2=Crowley\|first2=Kathy\|date=2012\|title=Anesthesia considerations during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy\|url=https://pubmed.ncbi.nlm.nih.gov/23021714\|journal=Surgical Oncology Clinics of North America\|volume=21\|issue=4\|pages=533–541\|doi=10.1016/j.soc.2012.07.003\|issn=1558-5042\|pmid=23021714\|via=}}</ref>		* Obtain pre-HIPEC chemistries (Na+, K+, Mg2+, Ca2+)<ref>{{Cite journal\|last=Rothfield\|first=Kenneth P.\|last2=Crowley\|first2=Kathy\|date=2012\|title=Anesthesia considerations during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy\|url=https://pubmed.ncbi.nlm.nih.gov/23021714\|journal=Surgical Oncology Clinics of North America\|volume=21\|issue=4\|pages=533–541\|doi=10.1016/j.soc.2012.07.003\|issn=1558-5042\|pmid=23021714\|via=}}</ref>

Line 212:		Line 221:

	* After fascia is closed, check twitches and reverse paralysis		* After fascia is closed, check twitches and reverse paralysis
	* Plan for extubation if hemodynamically stable, normothermic and normoxic		* Plan for extubation if hemodynamically stable, normothermic and normoxic.

	== Postoperative management ==		== Postoperative management ==

Chris.Rishel: Text replacement - "Art line" to "Arterial line"

2022-04-05T19:40:11Z

Text replacement - "Art line" to "Arterial line"

← Older revision		Revision as of 12:40, 5 April 2022
Line 3:		Line 3:
	\| airway = ETT		\| airway = ETT
	\| lines_access = Large bore IV x2		\| lines_access = Large bore IV x2
	~~Art~~ line		Arterial line
	Central line		Central line
	NG tube		NG tube

Chris.Rishel at 07:17, 5 April 2022

2022-04-05T07:17:38Z

← Older revision		Revision as of 00:17, 5 April 2022
Line 2:		Line 2:
	\| anesthesia_type = General		\| anesthesia_type = General
	\| airway = ETT		\| airway = ETT
	\| lines_access = Large bore ~~PIV X2~~		\| lines_access = Large bore IV x2
	Central ~~venous access~~		Art line
	~~Nasogastric~~ tube		Central line
	\| monitors = Standard ~~ASA monitors~~		NG tube
	~~Arterial Line (consider cardiac output monitoring)~~		\| monitors = Standard
	~~Central venous pressure~~		5-lead ECG
			ABP
			CVP
	\| considerations_preoperative = Baseline renal function		\| considerations_preoperative = Baseline renal function
	Electrolyte status		Electrolyte status
Line 344:		Line 346:

	[[Category:Surgical procedures]]		[[Category:Surgical procedures]]
			<references />
			[[Category:General surgery]]

Chris.Rishel: Text replacement - "|Respiratory" to "|Pulmonary"

2022-02-22T05:45:09Z

Text replacement - "|Respiratory" to "|Pulmonary"

← Older revision		Revision as of 22:45, 21 February 2022
Line 92:		Line 92:
	\|Cardiomyopathy risk based upon chemotherapy agents used		\|Cardiomyopathy risk based upon chemotherapy agents used
	\|-		\|-
	\|~~Respiratory~~		\|Pulmonary
	\|Pneumonitis based upon chemotherapy agents used		\|Pneumonitis based upon chemotherapy agents used
	\|-		\|-

Karen.Sibert at 21:41, 14 November 2021

2021-11-14T21:41:22Z

← Older revision		Revision as of 14:41, 14 November 2021
Line 22:		Line 22:
	Prolonged vasoplegia		Prolonged vasoplegia
	Sodium thiosulfate infusion (12 hrs)		Sodium thiosulfate infusion (12 hrs)
	}}'''Hyperthermic ~~intraperitonal~~ chemotherapy surgery (HIPEC)''' and '''cytoreductive surgery''' is a combined procedure utilized to treat peritoneal surface cancers.<ref name=":0">{{Cite journal\|last=Webb\|first=Christopher Allen-John\|last2=Weyker\|first2=Paul David\|last3=Moitra\|first3=Vivek K.\|last4=Raker\|first4=Richard K.\|date=2013\|title=An overview of cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion for the anesthesiologist\|url=https://pubmed.ncbi.nlm.nih.gov/23460568\|journal=Anesthesia and Analgesia\|volume=116\|issue=4\|pages=924–931\|doi=10.1213/ANE.0b013e3182860fff\|issn=1526-7598\|pmid=23460568\|via=}}</ref> These cancers include secondary peritoneal carcinomatosis, pseudomyxoma peritonei and primary peritoneal tumors.<ref name=":0" /><ref>{{Cite journal\|last=Macrì\|first=Antonio\|date=2010-01-15\|title=New approach to peritoneal surface malignancies\|url=https://pubmed.ncbi.nlm.nih.gov/21160811\|journal=World Journal of Gastrointestinal Oncology\|volume=2\|issue=1\|pages=9–11\|doi=10.4251/wjgo.v2.i1.9\|issn=1948-5204\|pmc=2999159\|pmid=21160811}}</ref> Cytoreductive surgery involves debulking the majority of tumors until the remainder are small enough to ensure adequate efficacy with HIPEC.		}}'''Hyperthermic intraperitoneal chemotherapy surgery (HIPEC)''' and '''cytoreductive surgery''' is a combined procedure utilized to treat peritoneal surface cancers.<ref name=":0">{{Cite journal\|last=Webb\|first=Christopher Allen-John\|last2=Weyker\|first2=Paul David\|last3=Moitra\|first3=Vivek K.\|last4=Raker\|first4=Richard K.\|date=2013\|title=An overview of cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion for the anesthesiologist\|url=https://pubmed.ncbi.nlm.nih.gov/23460568\|journal=Anesthesia and Analgesia\|volume=116\|issue=4\|pages=924–931\|doi=10.1213/ANE.0b013e3182860fff\|issn=1526-7598\|pmid=23460568\|via=}}</ref> These cancers include secondary peritoneal carcinomatosis, pseudomyxoma peritonei and primary peritoneal tumors.<ref name=":0" /><ref>{{Cite journal\|last=Macrì\|first=Antonio\|date=2010-01-15\|title=New approach to peritoneal surface malignancies\|url=https://pubmed.ncbi.nlm.nih.gov/21160811\|journal=World Journal of Gastrointestinal Oncology\|volume=2\|issue=1\|pages=9–11\|doi=10.4251/wjgo.v2.i1.9\|issn=1948-5204\|pmc=2999159\|pmid=21160811}}</ref> Cytoreductive surgery involves debulking the majority of tumors until the remainder are small enough to ensure adequate efficacy with HIPEC.

	HIPEC involves infusing heated cytotoxic chemotherapeutic drugs directly into the surgical site in order to effectively penetrate involved cancer while limiting exposure to normal tissue and decrease systemic uptake.<ref name=":0" /><ref name=":1">{{Cite journal\|last=Schmidt\|first=C.\|last2=Moritz\|first2=S.\|last3=Rath\|first3=S.\|last4=Grossmann\|first4=E.\|last5=Wiesenack\|first5=C.\|last6=Piso\|first6=P.\|last7=Graf\|first7=B. M.\|last8=Bucher\|first8=M.\|date=2009-09-15\|title=Perioperative management of patients with cytoreductive surgery for peritoneal carcinomatosis\|url=https://pubmed.ncbi.nlm.nih.gov/19697426\|journal=Journal of Surgical Oncology\|volume=100\|issue=4\|pages=297–301\|doi=10.1002/jso.21322\|issn=1096-9098\|pmid=19697426}}</ref><ref>{{Cite journal\|last=Al-Shammaa\|first=Hassan-Alaa-Hammed\|last2=Li\|first2=Yan\|last3=Yonemura\|first3=Yutaka\|date=2008-02-28\|title=Current status and future strategies of cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis\|url=https://pubmed.ncbi.nlm.nih.gov/18300340\|journal=World Journal of Gastroenterology\|volume=14\|issue=8\|pages=1159–1166\|doi=10.3748/wjg.14.1159\|issn=1007-9327\|pmc=2690662\|pmid=18300340}}</ref> This may be performed in a closed abdomen via perfusion circuit or an open abdomen +/- cavity expanders.<ref>{{Cite journal\|last=Witkamp\|first=A. J.\|last2=de Bree\|first2=E.\|last3=Van Goethem\|first3=R.\|last4=Zoetmulder\|first4=F. A.\|date=2001\|title=Rationale and techniques of intra-operative hyperthermic intraperitoneal chemotherapy\|url=https://pubmed.ncbi.nlm.nih.gov/11908929\|journal=Cancer Treatment Reviews\|volume=27\|issue=6\|pages=365–374\|doi=10.1053/ctrv.2001.0232\|issn=0305-7372\|pmid=11908929\|via=}}</ref> An open abdomen technique may reduce increased intraabdominal pressures and prevent reuse of the cytotoxic solution. However, the closed abdomen technique reduces risk of exposure of the medications to the OR staff.		HIPEC involves infusing heated cytotoxic chemotherapeutic drugs directly into the surgical site in order to effectively penetrate involved cancer while limiting exposure to normal tissue and decrease systemic uptake.<ref name=":0" /><ref name=":1">{{Cite journal\|last=Schmidt\|first=C.\|last2=Moritz\|first2=S.\|last3=Rath\|first3=S.\|last4=Grossmann\|first4=E.\|last5=Wiesenack\|first5=C.\|last6=Piso\|first6=P.\|last7=Graf\|first7=B. M.\|last8=Bucher\|first8=M.\|date=2009-09-15\|title=Perioperative management of patients with cytoreductive surgery for peritoneal carcinomatosis\|url=https://pubmed.ncbi.nlm.nih.gov/19697426\|journal=Journal of Surgical Oncology\|volume=100\|issue=4\|pages=297–301\|doi=10.1002/jso.21322\|issn=1096-9098\|pmid=19697426}}</ref><ref>{{Cite journal\|last=Al-Shammaa\|first=Hassan-Alaa-Hammed\|last2=Li\|first2=Yan\|last3=Yonemura\|first3=Yutaka\|date=2008-02-28\|title=Current status and future strategies of cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis\|url=https://pubmed.ncbi.nlm.nih.gov/18300340\|journal=World Journal of Gastroenterology\|volume=14\|issue=8\|pages=1159–1166\|doi=10.3748/wjg.14.1159\|issn=1007-9327\|pmc=2690662\|pmid=18300340}}</ref> This may be performed in a closed abdomen via perfusion circuit or an open abdomen +/- cavity expanders.<ref>{{Cite journal\|last=Witkamp\|first=A. J.\|last2=de Bree\|first2=E.\|last3=Van Goethem\|first3=R.\|last4=Zoetmulder\|first4=F. A.\|date=2001\|title=Rationale and techniques of intra-operative hyperthermic intraperitoneal chemotherapy\|url=https://pubmed.ncbi.nlm.nih.gov/11908929\|journal=Cancer Treatment Reviews\|volume=27\|issue=6\|pages=365–374\|doi=10.1053/ctrv.2001.0232\|issn=0305-7372\|pmid=11908929\|via=}}</ref> An open abdomen technique may reduce increased intraabdominal pressures and prevent reuse of the cytotoxic solution. However, the closed abdomen technique reduces risk of exposure of the medications to the OR staff.

Chris.Rishel at 09:49, 9 July 2021

2021-07-09T09:49:55Z

← Older revision		Revision as of 02:49, 9 July 2021
Line 246:		Line 246:
	\|Unique considerations		\|Unique considerations
	\|		\|
	\|Decreased exposure and inhalation		\|Decreased exposure and inhalation of chemotherapeutic agents
	of chemotherapeutic agents

	High intrabdominal pressures		High intrabdominal pressures
	\|		\|
Line 259:		Line 257:
	\|Surgical time		\|Surgical time
	\|		\|
	\|Variable, dependent on ~~tumor extent /~~		\|Variable, dependent on extent of tumor and resection

	extent of ~~surgical~~ resection
	\|		\|
	\|-		\|-
	\|Perfusion Time		\|Perfusion Time
	\|		\|
	\|Cisplatin: ~~90min~~		\|Cisplatin: 90 minutes
	MMC: ~~100min~~		MMC: 100 minutes
	\|		\|
	\|-		\|-
	\|EBL		\|EBL
	\|		\|
	\|Variable, dependent on ~~tumor extent/~~		\|Variable, dependent on extent of tumor and resection

	extent of ~~surgical~~ resection
	\|		\|
	\|-		\|-
Line 286:		Line 280:
	\|PCEA, IV acetaminophen		\|PCEA, IV acetaminophen

	~~occasionally~~ ketoralac (if ~~perfusion~~ with MMC~~, no pre-existing~~ kidney disease)		Consider ketoralac if:

			* Perfusion with MMC
			* No kidney disease
	\|		\|
	\|-		\|-
Line 318:		Line 315:
	\|-		\|-
	\|Intravenous Fluids		\|Intravenous Fluids
	\|Goal directed (UOP of 0.~~5mL~~/kg/h)		\|Goal directed (UOP of 0.5 mL/kg/h)
	\|		\|
	\|		\|
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	\|-		\|-
	\|Oral Intake		\|Oral Intake
	\|Clear liquid on POD 0. No NGT tube		\|Clear liquid on POD 0
			No NGT tube
	\|		\|
	\|		\|