J. Esquivel et al., Hemodynamic and cardiac function parameters during heated intraoperative intraperitoneal chemotherapy using the open "coliseum technique", ANN SURG O, 7(4), 2000, pp. 296-300
Background: Heated intraoperative intraperitoneal chemotherapy achieves hig
h peritoneal concentrations with limited systemic absorption and has become
an important tool in the management of patients with peritoneal carcinomat
osis from low-grade malignancies such as pseudomyxoma peritonei and in sele
cted cases of high-grade tumors such as colon adenocarcinoma. When the clos
ed abdomen technique is used, its perioperative toxicity seems to be relate
d to the hemodynamic and cardiac function changes associated with increased
body temperature and increased intra-abdominal pressure.
Methods: Hemodynamic and cardiac function variables during heated intraoper
ative intraperitoneal chemotherapy, using an open abdomen "coliseum techniq
ue," were measured in 15 patients with the use of a noninvasive esophageal
Doppler monitor.
Results: The hemodynamic and cardiac function changes were characterized by
an increased heart rate, increased cardiac output and decreased systemic v
ascular resistance associated with an increased body temperature, and decre
ased effective circulating volume with the urinary output tending to decrea
se as the therapy progressed.
Conclusion: Heated intraoperative intraperitoneal chemotherapy with the ope
n abdomen coliseum technique induces a hyperdynamic circulatory state with
an increased intravenous fluid requirement and avoids changes because of in
creased intra-abdominal pressure. Hemodynamic and cardiac stability, as doc
umented by normal blood pressure and adequate urinary output, can be achiev
ed by liberal intravenous fluids, titrated to frequent urinary output deter
mination.