Critical Care Issues in Oncological Surgery Patients
Section snippets
Cytoreductive surgery and heated intraperitoneal chemotherapy
CRS with HIPEC is emerging as a therapeutic option for advanced, locally metastatic abdominal cavity cancer or peritoneal carcinomatosis. In peritoneal cancer, intravenous chemotherapy is ineffective. CRS encompasses extensive tumor debulking with visceral and parietal peritonectomy, resection of omentum, and resections of involved abdominal viscera such as stomach, small bowel, colon, spleen, liver, gall bladder, pancreas, bladder, diaphragm, and abdominal wall.4, 5, 6 HIPEC is the
Airway Management
In critically ill patients, tracheal intubation is considerably more difficult due to factors such as encephalopathy, respiratory dysfunction, oropharyngeal secretions, hemodynamic instability, bleeding, vomiting, and airway edema. As the number of laryngoscopic intubation attempts increase, complications such as hypoxemia, aspiration, bradycardia, and cardiac arrest increase significantly.32
Traditional endotracheal intubation performed via direct laryngoscopy using devices such as the
Summary
As life expectancy increases and advances in cancer treatment more often convert deadly conditions into more chronic diseases, the surgical intensivist can expect to be faced with greater numbers of oncology patients undergoing aggressive surgical treatments for curative intent, prolonging survival, or primary palliation by alleviating obstruction, infection, bleeding, or pain. CRS and HIPEC are a paradigm for the emerging field of multimodal aggressive oncological surgery. A discussion of the
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Cited by (17)
Perianesthesia Measurement During Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Procedure: A Case Report and Review of the Literature
2019, Journal of Perianesthesia NursingCitation Excerpt :Surgeon will rock the abdomen throughout HIPEC to improve drug distribution to all peritoneal surfaces.24 The direct intra-abdominal infusion of chemotherapeutic drugs into malignant tissue maximizes exposure to high concentrations of chemotherapeutic drugs (20 to 1,000 times greater than plasma levels), whereas minimizing exposure of the normal tissue.25,26 Meanwhile, intra-abdominal infusing chemotherapeutic drugs are high-molecular-weight hydrophilic drugs that are unable to cross the peritoneal fluid-plasma barrier and demonstrate slow peritoneal clearance.27-30
Best practice for perioperative management of patients with cytoreductive surgery and HIPEC
2017, European Journal of Surgical OncologyCitation Excerpt :Patients undergoing cytoreductive surgery and HIPEC are at very high risk of venous thromboembolism (VTE).50 Reported incidence for venous thromboembolism is between 5 and 10%.134,135 Routine screening of this specific high-risk population including CT and bilateral Doppler ultrasonography of the legs before discharge was recommended.
Chinese experts consensus on the prevention and treatment of complications caused by intraperitoneal perfusion chemotherapy for gastrointestinal tumors (2022 edition)
2022, Chinese Journal of Gastrointestinal Surgery / Zhonghua Wei Chang Wai Ke Za ZhiTigecycline-induced coagulopathy: a literature review
2020, International Journal of Clinical PharmacyIntensive Care Practice in the Cancer Patient Population: Special Considerations and Challenges
2018, Current Anesthesiology Reports
The authors state that they do not have any conflicts of interest.