Anesthetic management and renal function in pediatric patients undergoing cytoreductive surgery with continuous hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin.

BACKGROUND: Extensive tumor implants secondary to sarcoma, sarcomatosis, or mesothelioma in children is rare. We conducted the first phase 1 trial of escalating doses of cisplatin during hyperthermic intraperitoneal chemotherapy (HIPEC) in children with sarcomatosis. The most devastating complication of cisplatin therapy is nephrotoxicity. Here we present the anesthetic management and analysis of the impact of intraoperative fluid management on the incidence of renal failure. METHODS: Of the 10 patients under 18 years of age who underwent HIPEC in the context of our phase 1 trial, six patients were under the age of 10 years. We reviewed the anesthetic management, intraoperative fluid and blood administration, and postoperative renal function in these patients. RESULTS: The average age and weight were 6 years and 20.9 kg, respectively. To avoid renal toxicity, urine output was maintained at an average of 3 ml/kg/h. Crystalloid and colloid were transfused at an average rate of 9 ml/kg/h. Percentage increase in creatinine postoperatively varied from 33 to 500 %. Volume of fluid administered did not correlate with percentage increase in creatinine. All patients had a temporary increase in their serum creatinine, but none required dialysis. CONCLUSIONS: Fluid administration at an average rate of 9 ml/kg/h was required to maintain satisfactory urine output. This rate of intraoperative fluid administration is similar to what is provided to adult HIPEC patients. There was no significant correlation in the volume or type of fluid delivered and the increase in serum creatinine. More studies are needed to determine optimal fluid management in children undergoing HIPEC with cisplatin.

Awake craniotomy: a practice overview.

Craniotomies are a common neurological intervention for intracranial tumor resections. Anesthesia techniques allow surgeons to aggressively and optimally resect neoplastic tissue while sparing normal cerebral tissue. Awake craniotomies are surgical techniques that enable surgeons to avoid damaging normal cerebral regions and allow real-time patient feedback. Such surgical interventions would not be possible without anesthesia. The role of anesthesia providers is critical in gaining the trust and motivation of the patient. Preoperative evaluation, regional anesthesia, general anesthesia, and monitored anesthesia are necessary to achieve a successful surgical intervention with awake craniotomy. As awake craniotomy gains more popularity, dependable anesthesia techniques remain critical. A discussion follows of the role of anesthesia providers in awake craniotomy during the entire perioperative continuum.