Potential risks of thoracic epidural analgesia in hyperthermic intraperitoneal chemotherapy

Abstract

This study proposes the new concept of reducing the birefringence of poly(ethylene naphthalate) (PEN) by a novel alloy with fluorene‐based polyester (FBP) involving the “cardo” structure in it. The alloys composed of PEN and FBP were prepared by simple melt blending method (process A) and reactive melt blending (process B). The resulting alloys were characterized by DSC, XRD, DMA, tensile testing, and polarized light microscopy. All PEN‐FBP alloys showed transparency and a single glass transition temperature (Tg), indicating that PEN‐FBP alloys were completely compatible. It was also demonstrated that Tg for PEN was shifted to the high‐temperature side by alloying with FBP. A large amount of the orientation‐induced birefringence was induced in drawn PEN sheets; however, in the cases of PEN‐FBP alloys, it was drastically decreased because of alloying with FBP. We could reveal the new concept for “low‐orientation‐induced birefringence material.” POLYM. ENG. SCI., 2009. © 2009 Society of Plastics Engineers

Thoracic epidural anesthesia in patients with cytoreductive surgery and HIPEC

“…However, we are in line with Desgranges and coworkers 10 that further investigations are absolutely necessary to assess the safety of epidural analgesia in extensive debulking surgery and HIPEC.…”

Epidural analgesia for cytoreductive surgery with peritonectomy and heated intraperitoneal chemotherapy

“…In 2010 Desgranges published a critic letter emphasising the problems related to the use of epidural analgesia after CRS and HIPEC [13]. In 2012 the same author analyzed the safety of epidural analgesia in patients undergoing HIPEC, but his conclusions did not confirm the safety of this analgesic technique (despite no cases of epidural hematoma) due to poor sample size at disposal (35 patients) [14].…”

Lack of significant intraoperative coagulopathy in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) indicates that epidural anaesthesia is a safe option

“…Intraoperative coagulopathy is a known complication of extensive surgery and HIPEC [30,31] and is probably caused by a combination of factors that include the high fluid volume required for resuscitation, the direct effect of intraperitoneal chemotherapy, hepatic toxicity due to antineoplastic agents and direct hepatic trauma [30]. In our series of patients, statistically significant alterations were recorded in all parameters studied except total number of GpIIb/IIIa platelet receptors which showed no significant variation throughout the procedure.…”

“…Although the effects of HIPEC on haemodynamics and fluid balance have been previously described, the effect on coagulation remains insufficiently understood. This makes the choice of epidural analgesia debatable in cytoreductive operations [9,15,30,31]. A question for further study is whether the known haemodynamic effects of epidural analgesia are intensified during HIPEC while disorders of haemostasis will increase the risk of epidural haematoma.…”