Hemodynamic Monitoring During Heated Intraoperative Intraperitoneal Chemotherapy Using the FloTrac/Vigileo System

Abstract

Cytoreductive surgery with HIPEC has provided a chance for long-term survival in selected patients. However, perioperative management remains a challenge for the anesthesiology team. The aim of this study was to evaluate the changes in hemodynamic parameters during hyperthermic intraperitoneal chemotherapy (HIPEC) using the FloTrac/ Vigileo system. Forty-one consecutive patients undergoing cytoreductive surgery and HIPEC were enrolled. Heart rate (HR), esophageal temperature, and cardiac output (CO) steadily increased until the end of HIPEC. In the first half of HIPEC, systolic blood pressure (SBP) and central venous pressure (CVP) increased whereas systemic vascular resistance (SVR) decreased; SVR stabilized in the second half. Diastolic blood pressure (DBP), mean arterial pressure (MAP), and stroke volume (SV) showed no significant variation. Male gender was related to increased CVP, CO, and SV, and decreased SVR; age .55 years was related to increased SBP, and peritoneal cancer index (PCI) was correlated with HR, DBP, and SV. PCI .14 was associated with increased HR and decreased DBP and MAP. American Society of Anesthesiologists score .1 was related to decreased CO and SV. Patients undergoing HIPEC develop a hyperdynamic circulatory state because of the increased temperature, characterized by a steady decrease in SVR and continuous increase in HR and CO. FloTrac/Vigileo system may provide an easy-to-handle, noninvasive monitoring tool.

A pilot randomised clinical trial comparing desflurane anaesthesia vs total intravenous anaesthesia, for changes in haemodynamic, inflammatory and coagulation parameters in patients undergoing hyperthermic intraperitoneal chemotherapy

“…Changes in MAP in response to HIPEC are variable, with few studies showing stable MAP and others showing a significant decrease. [ 3 10 11 12 ] MAP variations are also governed by the use of vasopressors (norepinephrine), intravascular volume and changes in SVR. But in the present study, the use of vasoactive drug support, blood loss and administered fluids in both groups were comparable.…”

“…An increase in HR has been reported in previous studies also attributed to the body's initial responses to hyperthermia, to maintain CO in the face of decreasing SVR, splanchnic heating or abdominal distention. [ 2 10 11 12 13 14 ]…”

“…These findings were similar to those of previous studies, wherein SVR decreased during HIPEC in response to systemic hyperthermia. [ 2 11 13 ]…”

Anesthetic implications in hyperthermic intraperitoneal chemotherapy

“…[ 27 ] Functional hemodynamic monitoring in the form of CO, SVV and DELTA SV particularly when PCI is recommended >15 to guide the goal directed fluid therapy to maintain normovolemia and prevent acute renal failure. [ 28 ] Extravascular lung water (EVLW) is the amount of water that is present outside the pulmonary vasculature. It includes interstitial, intracellular, alveolar and lymphatic fluid and does not include pleural effusions.…”

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Fluid and temperature remain the culprit!

“…[ 13 14 ] The non-invasive cardiac output monitoring and urine output appear to be an acceptable monitoring tool in such surgeries. [ 17 ] The fluid management was guided by non-invasive continuous cardiac output monitoring with FloTrac in patients with high tumour load and patient having persistent haemodynamic perturbations in the study being published. [ 10 ] Another randomised controlled trial which studied various outcomes related to CRS and HIPEC reported that the use of a goal-directed fluid therapy using the FloTrac/Vigileo was associated with improved patient-related outcome for major abdominal and systemic post-operative complications and reduced length of hospital stay.…”