Anaesthesia for intra-peritoneal perfusion of hyperthermic chemotherapy. Haemodynamic changes, oxygen consumption and delivery.

Abstract

We investigated the intra-operative application of intraperitoneal perfusion of hyperthermic chemotherapy and its effects on cardiovascular status and oxygen consumption and delivery in 11 patients following laparotomy for surgical resection of recurrent tumours or peritoneal metastases. Closed peritoneal irrigation was carried out with perfusate at a temperature of 45-47 degrees C. External cooling was applied during the procedure to prevent systemic hyperthermia. Data were collected 5 min before the commencement of the hyperthermic peritoneal perfusion, at 5, 30, 60 and 90 min during perfusion and 5 min after perfusion was discontinued. During the hyperthermic perfusion period, the core body temperature increased significantly but remained within clinically acceptable values. Heart rate, central venous pressure and pulmonary artery pressure increased significantly during perfusion; these returned to control values immediately after discontinuation of perfusion, except for the heart rate, which remained high. Mean arterial pressure, cardiac output, oxygen delivery and oxygen consumption did not change significantly although a metabolic acidosis developed during the study period. These findings suggest that the intraperitoneal perfusion of hyperthermic chemotherapy may be safe in humans, provided that appropriate monitoring, cooling and technical support are applied.