Anaesthetic management of extra-pleural pneumonectomy and hyperthermic intrathoracic chemotherapy procedure

Our plain-English summary of Anaesthetic management of extra-pleural pneumonectomy and hyperthermic intrathoracic chemotherapy procedure, by J.K. Ramegowda, M.A. Salam, V. Nayak, et al (Indian Journal of Anaesthesia, 2015).

The study

• Authors: J.K. Ramegowda, M.A. Salam, V. Nayak, S. Zaveri
• Journal: Indian Journal of Anaesthesia
• Published: 2015;59(12):807-10
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma is a rare tumour with survival of 9-17 months after diagnosis. Radical surgical resection by extra-pleural pneumonectomy combined with hyperthermic intrathoracic chemotherapy has shown to improve patient survival and better microscopic tumour control. Anaesthetic management of this procedure is challenging due to the complex pathophysiological changes associated with prolonged duration of surgery, one- lung ventilation, haemodynamic instability due to major blood loss, temperature variations including heat loss during pneumonectomy and rapid rise in temperature during hyperthermic chemotherapy, cardiac arrhythmias due to exposure to heated chemotherapeutics, cisplatin toxicity and acid-base changes. Intra-operative management involves protective ventilation, regulation of temperature and haemodynamics along with prevention of complications associated with 'heated chemotherapeutics'. Thorough pre-operative assessment and preparation, advanced intra-operative monitoring with prompt corrective interventions, will help in improved patient outcome in the immediate post-operative period. We present one such case done for the 1(st) time in India.

In plain English

This article was a case report from Manipal Hospital, Bengaluru, India, describing the anaesthetic care of one patient during surgery for malignant pleural mesothelioma. The authors described the case as the first such procedure done in India. The patient, a 58-year-old man with right-sided malignant pleural mesothelioma, had an extra-pleural pneumonectomy (removal of the lung, pleura, pericardium and part of the diaphragm). This was followed by heated chemotherapy with cisplatin circulated inside the chest for 60 minutes. The whole operation took 13 hours, and total blood loss was 3000 ml. During the heated chemotherapy, the patient's core temperature rose from 34.2°C to 37°C despite active cooling. The patient stayed haemodynamically stable, had no arrhythmias, and was extubated in the operating room. After surgery the patient had mild low potassium, a drop in haemoglobin to 8 g%, and a marginal rise in serum creatinine that later normalised. The patient went home on the 10th day after surgery. The article does not report any asbestos exposure history. The authors concluded that careful assessment, advanced monitoring and prompt corrective action help improve patient outcome.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 58-year-old man with right-sided malignant pleural mesothelioma, treated at Manipal Hospital, Bengaluru, India; the date of the case is not given
• Exposure: No asbestos or other occupational exposure is reported. The article describes treatment, not exposure: heated intrathoracic chemotherapy with cisplatin 150 mg/m2 (total dose 260 mg) in 3.5 L of fluid at 42.5°C, circulated for 60 minutes
• Main results:
  • For this patient, total surgical duration was 13 hours and total blood loss was 3000 ml
  • During the heated chemotherapy, the patient's temperature rose from 34.2°C at the start to 37°C at the end
  • The patient remained haemodynamically stable with no arrhythmias throughout the procedure
  • The patient was extubated in the operating room and moved to intensive care
  • On the first day after surgery the patient had mild hypokalaemia and haemoglobin fell to 8 g%
  • Serum creatinine rose marginally during the first five days after surgery and later returned to normal
  • The patient was discharged on the 10th day after surgery
• The authors' conclusion: The authors concluded that anaesthetic management of this procedure involves protective lung ventilation, control of temperature and circulation, and prevention of complications from heated chemotherapy. In their view, thorough preparation and advanced monitoring with prompt corrective interventions will help improve patient outcome.

Topics

Medical terms in this study, explained in our Lexicon: Pneumonectomy, Intrathoracic, Chemotherapy, Pleural Mesothelioma, Surgical Resection, Cisplatin.

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