What is it about?

Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has become an important therapeutic option in pediatric patients with extensive or refractory abdominal tumors. This aggressive treatment is complex, not only regarding surgical technique, but also regarding anesthetic management. We present the anesthetic management and postoperative pain control strategies for pediatric CRS-HIPEC utilizing a novel protocol.

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Why is it important?

This is the largest case series on the anesthetic, fluid, and pain management of pediatric CRS-HIPEC ever reported. Utilizing a novel anesthetic and post operative pain management protocol, we were able to avoid the need for postoperative intubation, allow for early ambulation, and minimize both intraoperative and postoperative opioid requirements. This is a major advancement for the management of this complex surgical procedure.

Perspectives

I believe the perioperative anesthetic protocol detailed in this article can be utilized at any facility for not only pediatric CRS-HIPEC but potentially for any other open abdominal surgical procedure. The ability of this perioperative protocol to eliminate the need for post-operative ventilation and decrease or negate the need for IV opioids is a major advancement for the management of this complex surgical procedure.

Adam Suchar
University of North Carolina at Chapel Hill

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This page is a summary of: Anesthesia and pain management of pediatric cytoreductive surgery with hyperthermic intraperitoneal chemotherapy, Pediatric Anesthesia, September 2022, Wiley, DOI: 10.1111/pan.14551.
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