The accuracy and haemodynamic monitoring power of Oesophageal Doppler is legendary. However it sometimes takes the demands of a complex procedure to reinforce the message.
One example is Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC). CRS with HIPEC is on the increase as its value has gained recognition. Candidates include those with colorectal peritoneal metastases and those considered “at risk” following extensive colorectal cancer surgery. CRS with HIPEC is itself a major surgical undertaking. It involves performing a large abdominal incision, multiple organ resection and application of heated chemotherapy fluid to the open cavity.
Throughout the procedure the anaesthetist faces with significant changes in status of blood volume, blood pressure, coagulation, respiratory, electrolytes and body temperature. Furthermore the effect of heated fluid during the HIPEC stage has a dilative effect with associated risk of hypotension.
One recent clinical case report* stated that “during the surgery and immediate postoperative period, patients face major and life-threatening derangements of their haemodynamic, respiratory and metabolic, physiologic balance.”
Fluid loss can be very high both during surgery and in the postoperative period. Associated complications can have a significant adverse patient impact if adequate organ perfusion is not maintained. Perioperative haemodynamic control therefore has a direct impact on outcomes.
We’ve added a new case study to the Deltex Medical Group plc (LON:DEMG) website on CRS/HIPEC. It describes the use of the company’s Oesophageal Doppler monitoring system (ODM+) in the monitoring and control of fluid status throughout a recently performed case. Described is the importance of understanding the impact of vasoactive drugs including Phenylephrine. Here’s a drug that anaesthetists administer to address the hypotension that results from HIPEC. However, while its use will increase blood pressure, it also results in a reduction in cardiac output and stroke volume. Systems that derive data from blood pressure monitoring alone would not elucidate these changes and could influence the anaesthetist to deliver less fluid, when the opposite is required to maintain organ perfusion.