Anesthesia Clinical Outcome and Management in Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: A Retrospective Analysis

Abstract

Background: Anesthetic technique and outcome of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is not well established. Objective: To evaluate the anesthetic management of CRS with HIPEC and to analyze whether supplement epidural anesthesia will provide any benefit on the outcomes. Materials and Methods: All patients that underwent CRS with HIPEC between January 2008 and December 2017 at King Chulalongkorn Memorial Hospital were retrospective reviewed. Patients were divided into two groups, 1) received a combination of epidural and general anesthesia (EGA), and 2) received general anesthesia (GA) to compare intraoperative hemodynamic stability, postoperative pain control, time to tracheal extubation, and postoperative complications between groups. Results: Twenty patients had EGA, and 14 patients had GA. EGA group had significant more incidences of intraoperative hypotension at 70% versus 21.4%, which required more use of vasopressor at 65% versus 21.4% (p<0.05). There was no statistical difference between groups in total blood loss, time to extubation, and ICU length of stay. There were no significant differences in the pain score at 12 and 24 hours postoperative. Epidural complications were not detected. There was no mortality within 30 days. Conclusion: Adding epidural analgesia to GA in CRS with HIPEC increased the incidence of hypotension and did not reduce the pain or duration of extubation. Keywords: Anesthesia; Epidural; HIPEC; Outcome