Perfusión aislada de extremidad inferior con fuga de quimioterapéutico / Isolated limb perfusion with cytostatic drug leakage

La perfusión aislada de la extremidad es el tratamiento del melanoma en estadio iii, con metástasis en tránsito. Esta técnica permite la administración de citostáticos a concentración y temperatura eficaces, que no podrían ser administrados de manera sistémica debido a su toxicidad. La toxicidad debido al paso a la circulación sistémica de quimioterápico procedente de la extremidad es la complicación más grave a corto plazo, y se manifiesta mediante el síndrome de respuesta inflamatoria sistémica en el postoperatorio inmediato. La detección precoz de esta complicación y su manejo perioperatorio requiere un abordaje multidiscilplicar, en el que el anestesiólogo tiene un papel clave. Presentamos un caso de perfusión aislada de la extremidad inferior en el que el procedimiento tuvo que ser interrumpido por paso de factor de necrosis tumoral a la circulación sistémica, con grave repercusión hemodinámica intraoperatoria (AU)

Isolated limb perfusion is the treatment of stage III melanoma with in-transit metastasis. This technique allows the administration of cytostatics at an effective concentration and temperature, which could not be administered systemically because of their toxicity. The toxicity due to leakage of the chemotherapy agent from the limb into the systemic circulation is the most serious short-term complication, and is manifested by a systemic inflammatory response syndrome in the immediate post-intervention period. Early detection of this complication and its peri-operative management requires a multidisciplinary approach, in which the anaesthesiologist plays a key role. A case of isolated lower limb perfusion is reported in which the procedure had to be interrupted due to the passage of tumour necrosis factor into the systemic circulation, with severe intra-operative haemodynamic repercussions (AU)

Isolated limb perfusion with cytostatic drug leakage. / Perfusión aislada de extremidad inferior con fuga de quimioterapéutico.

Isolated limb perfusion is the treatment of stage III melanoma with in-transit metastasis. This technique allows the administration of cytostatics at an effective concentration and temperature, which could not be administered systemically because of their toxicity. The toxicity due to leakage of the chemotherapy agent from the limb into the systemic circulation is the most serious short-term complication, and is manifested by a systemic inflammatory response syndrome in the immediate post-intervention period. Early detection of this complication and its peri-operative management requires a multidisciplinary approach, in which the anaesthesiologist plays a key role. A case of isolated lower limb perfusion is reported in which the procedure had to be interrupted due to the passage of tumour necrosis factor into the systemic circulation, with severe intra-operative haemodynamic repercussions.