Abstract
BackgroundHyperthermic isolated limb perfusion (HILP) is used for patients with intractable or extensive in-transit metastatic melanoma of the limb to deliver high concentrations of cytotoxic agents to the affected limb and offers a treatment option in a disease stage with a poor prognosis when no treatment is given.MethodsIn a retrospective chart review of 17 cases, we studied the anesthetic and hemodynamic changes during HILP and its management.ResultsHILP was well tolerated except in one case that is described herein. We present summary data of all cases undergoing upper and lower limb perfusion, discuss our current clinical practice of preoperative, perioperative and intraoperative patient care including the management of HILP circuit.ConclusionHILP is a challenging procedure, and requires a team effort including the surgical team, anesthesia care providers, perfusionists and nurses. Intraoperatively, invasive hemodynamic and metabolic monitoring is indispensable to manage significant hemodynamic and metabolic changes due to fluid shifts and release of cytokines.
Highlights
Hyperthermic isolated limb perfusion (HILP) is used for patients with intractable or extensive in-transit metastatic melanoma of the limb to deliver high concentrations of cytotoxic agents to the affected limb and offers a treatment option in a disease stage with a poor prognosis when no treatment is given
The technique delivers a high concentration of cytotoxic agents regionally to the affected limb and, minimizes systemic toxicity [2,3,4]
During the HILP procedure, a dynamic fluid shift exists between the systemic vascular compartment and the vascular compartment of the isolated limb, especially when the patient is placed upon and disconnected from the extracorporeal circuit [2,4]
Summary
Hyperthermic isolated limb perfusion (HILP) is used for patients with intractable or extensive in-transit metastatic melanoma of the limb to deliver high concentrations of cytotoxic agents to the affected limb and offers a treatment option in a disease stage with a poor prognosis when no treatment is given. The technique delivers a high concentration of cytotoxic agents regionally to the affected limb and, minimizes systemic toxicity [2,3,4]. During the HILP procedure, a dynamic fluid shift exists between the systemic vascular compartment and the vascular compartment of the isolated limb, especially when the patient is placed upon and disconnected from the extracorporeal circuit [2,4]. Anesthetic management of the procedure has not been much discussed, and no standard of practice has been established [11,12]
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