Anesthesia and Pain Management for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Desmoplastic Small Round Cell Tumors in Children, Adolescents, and Young Adults

Doralina L. Anghelescu, Christina Lin Brown, Andrew J. Murphy, Andrew M. Davidoff, Paxton V. Dickson, Evan Glazer, Zachary E. Stiles, Michael W. Bishop, Luke Douthitt, Jeremiah Deneve

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Abstract

Background: Desmoplastic small round cell tumor (DSRCT) is a rare, aggressive sarcoma. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) may improve survival. Methods: A retrospective review of anesthetic management and postoperative pain control strategies after CRS/HIPEC for DSRCT from 2013 to 2017 was performed. Results: The review analyzed 10 CRS/HIPEC procedures performed for nine DSRCT patients with a median age of 19 years (range 10–24 years). Six of these patients were Caucasian, and seven were men. The median operative duration was 551 min (range 510–725 min), and the median anesthesia duration was 621 min (range 480–820 min). Postoperative mechanical ventilation was necessary in 5 patients for a median duration of 1 day (range 0–2 days). The median intraoperative intravenous fluid administration was 13 ml/kg/h (range 6.3–24.4 ml/kg/h), and the colloid administration was 12 ml/kg (range 0.0–53.0 ml/kg). The median blood loss was 15 ml/kg (range 6.3–77.2 ml/kg). Nine patients received intraoperative transfusion with a median red blood cell transfusion volume of 14 ml/kg (range 10.1–58.5 ml/kg). The median intraoperative urine output was 2 ml/kg/h (range 0.09–8.40 ml/kg/h), and half of the patients received intraoperative diuretics. Cisplatin was used during HIPEC for eight surgeries. Acute kidney injury was observed in two patients, one of whom required short-term dialysis. Epidural infusions were used in eight cases for a median of 4 days (range 3–5 days). Postoperative intravenous opioid use (morphine equivalent) was 0.67 mg/kg/day (range 0.1–9.2 mg/kg/day) administered for a median of 11 days (range 2–35 days). Conclusion: Cytoreduction and HIPEC for DSRCT are associated with significant perioperative fluid requirements and potentially challenging pain management. Renal protective strategies should be considered for reduction of cisplatin-associated nephrotoxicity. Further investigation for a more effective, less systemically toxic HIPEC agent is warranted.

Original languageEnglish (US)
Pages (from-to)131-138
Number of pages8
JournalAnnals of Surgical Oncology
Volume26
Issue number1
DOIs
StatePublished - Jan 15 2019

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Desmoplastic Small Round Cell Tumor
Pain Management
Young Adult
Anesthesia
Drug Therapy
Cisplatin
Erythrocyte Transfusion
Poisons
Colloids
Postoperative Pain
Cell Size
Artificial Respiration
Diuretics
Acute Kidney Injury
Sarcoma
Intravenous Administration
Morphine
Opioid Analgesics
Anesthetics
Dialysis

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

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Anesthesia and Pain Management for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Desmoplastic Small Round Cell Tumors in Children, Adolescents, and Young Adults. / Anghelescu, Doralina L.; Brown, Christina Lin; Murphy, Andrew J.; Davidoff, Andrew M.; Dickson, Paxton V.; Glazer, Evan; Stiles, Zachary E.; Bishop, Michael W.; Douthitt, Luke; Deneve, Jeremiah.

In: Annals of Surgical Oncology, Vol. 26, No. 1, 15.01.2019, p. 131-138.

Research output: Contribution to journalArticle

Anghelescu, Doralina L. ; Brown, Christina Lin ; Murphy, Andrew J. ; Davidoff, Andrew M. ; Dickson, Paxton V. ; Glazer, Evan ; Stiles, Zachary E. ; Bishop, Michael W. ; Douthitt, Luke ; Deneve, Jeremiah. / Anesthesia and Pain Management for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Desmoplastic Small Round Cell Tumors in Children, Adolescents, and Young Adults. In: Annals of Surgical Oncology. 2019 ; Vol. 26, No. 1. pp. 131-138.
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abstract = "Background: Desmoplastic small round cell tumor (DSRCT) is a rare, aggressive sarcoma. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) may improve survival. Methods: A retrospective review of anesthetic management and postoperative pain control strategies after CRS/HIPEC for DSRCT from 2013 to 2017 was performed. Results: The review analyzed 10 CRS/HIPEC procedures performed for nine DSRCT patients with a median age of 19 years (range 10–24 years). Six of these patients were Caucasian, and seven were men. The median operative duration was 551 min (range 510–725 min), and the median anesthesia duration was 621 min (range 480–820 min). Postoperative mechanical ventilation was necessary in 5 patients for a median duration of 1 day (range 0–2 days). The median intraoperative intravenous fluid administration was 13 ml/kg/h (range 6.3–24.4 ml/kg/h), and the colloid administration was 12 ml/kg (range 0.0–53.0 ml/kg). The median blood loss was 15 ml/kg (range 6.3–77.2 ml/kg). Nine patients received intraoperative transfusion with a median red blood cell transfusion volume of 14 ml/kg (range 10.1–58.5 ml/kg). The median intraoperative urine output was 2 ml/kg/h (range 0.09–8.40 ml/kg/h), and half of the patients received intraoperative diuretics. Cisplatin was used during HIPEC for eight surgeries. Acute kidney injury was observed in two patients, one of whom required short-term dialysis. Epidural infusions were used in eight cases for a median of 4 days (range 3–5 days). Postoperative intravenous opioid use (morphine equivalent) was 0.67 mg/kg/day (range 0.1–9.2 mg/kg/day) administered for a median of 11 days (range 2–35 days). Conclusion: Cytoreduction and HIPEC for DSRCT are associated with significant perioperative fluid requirements and potentially challenging pain management. Renal protective strategies should be considered for reduction of cisplatin-associated nephrotoxicity. Further investigation for a more effective, less systemically toxic HIPEC agent is warranted.",
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AU - Anghelescu, Doralina L.

AU - Brown, Christina Lin

AU - Murphy, Andrew J.

AU - Davidoff, Andrew M.

AU - Dickson, Paxton V.

AU - Glazer, Evan

AU - Stiles, Zachary E.

AU - Bishop, Michael W.

AU - Douthitt, Luke

AU - Deneve, Jeremiah

PY - 2019/1/15

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N2 - Background: Desmoplastic small round cell tumor (DSRCT) is a rare, aggressive sarcoma. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) may improve survival. Methods: A retrospective review of anesthetic management and postoperative pain control strategies after CRS/HIPEC for DSRCT from 2013 to 2017 was performed. Results: The review analyzed 10 CRS/HIPEC procedures performed for nine DSRCT patients with a median age of 19 years (range 10–24 years). Six of these patients were Caucasian, and seven were men. The median operative duration was 551 min (range 510–725 min), and the median anesthesia duration was 621 min (range 480–820 min). Postoperative mechanical ventilation was necessary in 5 patients for a median duration of 1 day (range 0–2 days). The median intraoperative intravenous fluid administration was 13 ml/kg/h (range 6.3–24.4 ml/kg/h), and the colloid administration was 12 ml/kg (range 0.0–53.0 ml/kg). The median blood loss was 15 ml/kg (range 6.3–77.2 ml/kg). Nine patients received intraoperative transfusion with a median red blood cell transfusion volume of 14 ml/kg (range 10.1–58.5 ml/kg). The median intraoperative urine output was 2 ml/kg/h (range 0.09–8.40 ml/kg/h), and half of the patients received intraoperative diuretics. Cisplatin was used during HIPEC for eight surgeries. Acute kidney injury was observed in two patients, one of whom required short-term dialysis. Epidural infusions were used in eight cases for a median of 4 days (range 3–5 days). Postoperative intravenous opioid use (morphine equivalent) was 0.67 mg/kg/day (range 0.1–9.2 mg/kg/day) administered for a median of 11 days (range 2–35 days). Conclusion: Cytoreduction and HIPEC for DSRCT are associated with significant perioperative fluid requirements and potentially challenging pain management. Renal protective strategies should be considered for reduction of cisplatin-associated nephrotoxicity. Further investigation for a more effective, less systemically toxic HIPEC agent is warranted.

AB - Background: Desmoplastic small round cell tumor (DSRCT) is a rare, aggressive sarcoma. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) may improve survival. Methods: A retrospective review of anesthetic management and postoperative pain control strategies after CRS/HIPEC for DSRCT from 2013 to 2017 was performed. Results: The review analyzed 10 CRS/HIPEC procedures performed for nine DSRCT patients with a median age of 19 years (range 10–24 years). Six of these patients were Caucasian, and seven were men. The median operative duration was 551 min (range 510–725 min), and the median anesthesia duration was 621 min (range 480–820 min). Postoperative mechanical ventilation was necessary in 5 patients for a median duration of 1 day (range 0–2 days). The median intraoperative intravenous fluid administration was 13 ml/kg/h (range 6.3–24.4 ml/kg/h), and the colloid administration was 12 ml/kg (range 0.0–53.0 ml/kg). The median blood loss was 15 ml/kg (range 6.3–77.2 ml/kg). Nine patients received intraoperative transfusion with a median red blood cell transfusion volume of 14 ml/kg (range 10.1–58.5 ml/kg). The median intraoperative urine output was 2 ml/kg/h (range 0.09–8.40 ml/kg/h), and half of the patients received intraoperative diuretics. Cisplatin was used during HIPEC for eight surgeries. Acute kidney injury was observed in two patients, one of whom required short-term dialysis. Epidural infusions were used in eight cases for a median of 4 days (range 3–5 days). Postoperative intravenous opioid use (morphine equivalent) was 0.67 mg/kg/day (range 0.1–9.2 mg/kg/day) administered for a median of 11 days (range 2–35 days). Conclusion: Cytoreduction and HIPEC for DSRCT are associated with significant perioperative fluid requirements and potentially challenging pain management. Renal protective strategies should be considered for reduction of cisplatin-associated nephrotoxicity. Further investigation for a more effective, less systemically toxic HIPEC agent is warranted.

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