Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Jul 17;13(1):15.
doi: 10.1186/1471-2253-13-15.

Anesthesia management of patients undergoing hyperthermic isolated limb perfusion with melphalan for melanoma treatment: an analysis of 17 cases

Heiner Ruschulte  1 , Serena Shi, William W Tseng, Kerstin Kolodzie, Philip C Crawford, Darren B Schneider, Mohammed Kashani-Sabet, David Minor, Christian Apfel, Stanley Pl Leong
Affiliations

Anesthesia management of patients undergoing hyperthermic isolated limb perfusion with melphalan for melanoma treatment: an analysis of 17 cases

Heiner Ruschulte et al. BMC Anesthesiol. .

Abstract

Background: Hyperthermic isolated limb perfusion (HILP) is used for patients with intractable or extensive in-transit metastatic melanoma of the limb to deliver high concentrations of cytotoxic agents to the affected limb and offers a treatment option in a disease stage with a poor prognosis when no treatment is given.

Methods: In a retrospective chart review of 17 cases, we studied the anesthetic and hemodynamic changes during HILP and its management.

Results: HILP was well tolerated except in one case that is described herein. We present summary data of all cases undergoing upper and lower limb perfusion, discuss our current clinical practice of preoperative, perioperative and intraoperative patient care including the management of HILP circuit.

Conclusion: HILP is a challenging procedure, and requires a team effort including the surgical team, anesthesia care providers, perfusionists and nurses. Intraoperatively, invasive hemodynamic and metabolic monitoring is indispensable to manage significant hemodynamic and metabolic changes due to fluid shifts and release of cytokines.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Shown are the adjusted schock indices of 16/17 patients who tolerated the treatment well throughout all periods of the procedure. The course of the patient who went into circulatory arrest due to poor cardiac function, fluid imbalance, masked by a paced heartrate is displayed in comparison. All patients (n=16+1*).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Thompson JF, De Wilt JH. Isolated limb perfusion in the management of patients with recurrent limb melanoma: an important but limited role. Ann Surg Oncol. 2001;8:564–565. doi: 10.1007/s10434-001-0564-9. - DOI - PubMed
    1. Thompson JF, Kam PC. Current status of isolated limb infusion with mild hyperthermia for melanoma. Int J Hyperthermia. 2008;24:219–225. doi: 10.1080/02656730701827565. - DOI - PubMed
    1. Beasley GM, Ross MI, Tyler DS. Future directions in regional treatment strategies for melanoma and sarcoma. Int J Hyperthermia. 2008;24:301–309. doi: 10.1080/02656730701827573. - DOI - PubMed
    1. Schaadt J, Crowley R, Miller D, Kavanah M. Isolated limb perfusion: a literature review. J Extra Corpor Technol. 2002;34:130–143. - PubMed
    1. Creech O Jr, Krementz ET, Ryan RF, Winblad JN. Chemotherapy of cancer: regional perfusion utilizing an extracorporeal circuit. Ann Surg. 1958;148:616–632. doi: 10.1097/00000658-195810000-00009. - DOI - PMC - PubMed