Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and Intraoperative Electrolyte Disturbances—Implications for Anesthetic Management

Raytis, John L.; Lew, Michael W.

doi:10.4236/ojanes.2014.410036

Cited by 1 publication

(2 citation statements)

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“…Chloride seems to promote formation of the active cytotoxic drug form of oxaliplatin and therefore could enhance its cytotoxic effect [ 56 ]. In this study, glucose concentration increased during surgery, peaked during chemotherapy (related to the dextrose 5% solution used for chemotherapy instillation) but continued to be increased on day 3 and 7 postoperative [ 14 ]. In diabetic patients, the hyperglycemic byproduct methylglyoxal impairs anticoagulant activity through covalent adduction of antithrombin III [ 57 ].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the procedure has been depicted as a high risk with significant levels of comorbidity (22–39%), mortality (5%) and prolonged hospital stays [ 11 ]. Although cytoreductive surgery (CRS) and hyperthermic intraperitoneal preoperative chemotherapy (HIPEC) have established its therapeutic role in selected patient populations with peritoneal carcinomatosis (PC), multiple factors can disrupt the patient metabolism during and after surgery [ 12 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Thrombin generation and platelet activation in cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy - A prospective cohort study

et al. 2018

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Background and objectivesCytoreductive surgery (CRS) with hyperthermic intraperitoneal peroperative chemotherapy (HIPEC), indicated for patients with peritoneal metastases from digestive or gynecological malignancies alike, demonstrates a considerable impact on hemostatic metabolism, both on platelet and on coagulation level. The potential hemostatic interference in CRS and HIPEC is phase dependent. The hypothesis of this prospective cohort study is that the procedure exposed an increased thrombotic risk, resulting in a faster and increased thrombin generation and hyper platelet function.MethodsThis study explores the combined use of ROTEM (rotational thromboelastometry), PACT (platelet activation test) and CAT (thrombin generation test) assays during CRS and HIPEC with a follow-up of 7 days postoperative in 27 patients with confirmed histological diagnosis of peritoneal disease.ResultsPlatelet reactivity (relative to before incision values) to CRP (collagen-related peptide) (p value 0.02) and TRAP (thrombin receptor activator peptide) (p value 0.048) seems to be slightly reduced during CRS and HIPEC with regard to αIIbβ3 activation, while P-selectin expression is not affected. During surgery, CAT demonstrates that, the LT (lagtime) (p value 0.0003) and TTP (time-to-thrombin peak) values (p value 0.002) decrease while and the TP (thrombin peak) (p value 0.004) and ETP (endogenous thrombin potential) (p value 0.02) increase. Subsequently, after surgery, the LT and TTP increase and ETP and TP decrease in time. ROTEM EXTEM (extrinsic) MCF (maximum clot firmness) (p value 0.005), INTEM (intrinsic) MCF (p value 0.003) and FIBTEM (fibrinogen) MCF (p value <0.001) decreased during CRS. At day 7 INTEM and FIBTEM MCF values (p values of 0.004 and <0.001) were significantly higher than before surgery. No considerable changes in platelet count and hemoglobin concentration and absence of leukopenia are noticed.ConclusionThis approach detects changes in coagulation much earlier than noticed by standard coagulation tests.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Thrombin generation and platelet activation in cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy - A prospective cohort study

et al. 2018

View full text Add to dashboard Cite

show abstract

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and Intraoperative Electrolyte Disturbances—Implications for Anesthetic Management

Abstract: The administration of hyperthermic intraperitoneal chemotherapy (HIPEC) is often associated with significant intraoperative electrolyte changes. We retrospectively examined the pre-HIPEC and post-HIPEC intraoperative basic metabolic panel (

Cited by 1 publication

References 6 publications

Thrombin generation and platelet activation in cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy - A prospective cohort study

Thrombin generation and platelet activation in cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy - A prospective cohort study

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