Perioperative anesthetic management of patients with malignant pleural mesothelioma undergoing cytoreductive surgery and intraoperative chemotherapy

Introduction: Cytoreductive surgery with hyperthermic intraoperative chemotherapy (HITHOC) is a therapeutic option for treatment of malignant pleural mesothelioma. Anesthetic management might be challenging. Patients and methods: A descriptive analysis of a case series is presented. Seven patients with malignant pleural mesothelioma diagnostic undergoing HITHOC surgery were studied. Combined general and epidural anesthesia were administered. An intensive hemodynamic monitorization was implemented. Data regarding perioperative course was analyzed. Results: Between May 2015 and October 2018 7 patients underwent HITHOC procedure. Blood transfusions were administered in all patients, and 5 of the 7 patients required vasoactive drug administration. Extubation at the end of the procedure was able in 6 of the 7 patients. The median length of stay in ICU was 4 days, and 29 days for the whole hospitalary stay. No significant postoperative pain was observed. Conclusions: HITHOC surgery is a complex procedure in which several hemodynamic changes occur. An intensive intraoperative monitorization was useful for controlling complications. (C) 2019 Sociedad Espanola de Anestesiologia, Reanimation y Terapeutica del Dolor. Published by Elsevier Espana, S.L.U. All rights reserved.