Hemodynamic and cardiac function parameters during heated intraoperative intraperitoneal chemotherapy using the open "coliseum technique"

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.