Rouche Amir, Hübner Martin, Grass Fabian, Pache Basile, Demartines Nicolas, Blanc Catherine
Department of Anaesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Turk J Anaesthesiol Reanim. 2020 Aug;48(4):273-279. doi: 10.5152/TJAR.2019.15493. Epub 2019 Dec 26.
Pressurised intraperitoneal aerosol chemotherapy (PIPAC) is a new type of intraperitoneal chemotherapy for peritoneal carcinosis via minimally invasive surgery. This technique's specificity is the remote application of the therapy because of the potential risk of exposure to toxic products. The present paper summarises the important aspects of PIPAC and analyses the anaesthetic outcomes.
This retrospective study included all patients undergoing PIPAC treatment between January 2015 and February 2018. Data on protocol adherence and perioperative anaesthetic complications and postoperative nausea and vomiting (PONV) and pain levels (visual analogue scale 0-10) from recovery room to 72 h were analysed.
The overall analysis included 193 PIPAC procedures on 87 patients. Protocol adherence was high as regards the use of propofol (100%), rocuronium (98%), antiemetic prophylaxis (99%) and lidocaine intravenous (i.v.) (87%). No accidental exposure to chemotherapy occurred during the study period. Of the 87 patients, 6.3% suffered delayed recovery, 58% due to hypothermia and 42% due to excessive sedation or curarisation. In the recovery room, 16% of patients suffered moderate to severe pain, requiring >8 mg of morphine i.v., with average doses of 13.7 mg. Median postoperative pain scores were 1 and 3 at 12 h and 0 and 0 at 72 h at rest and mobilisation, respectively. PONV was observed in <10% of patients during the first 12 h, but in 40% at 72 h.
A dedicated anaesthetic protocol and intraoperative safety checklist facilitates safe, well-tolerated anaesthesia for PIPAC treatments.
腹腔内加压气溶胶化疗（PIPAC）是一种通过微创手术治疗腹膜癌的新型腹腔内化疗方法。由于存在接触有毒产物的潜在风险，该技术的特殊性在于治疗的远程应用。本文总结了PIPAC的重要方面并分析了麻醉效果。
这项回顾性研究纳入了2015年1月至2018年2月期间接受PIPAC治疗的所有患者。分析了方案依从性、围手术期麻醉并发症以及从恢复室到术后72小时的术后恶心呕吐（PONV）和疼痛程度（视觉模拟评分0 - 10）的数据。
总体分析包括对87例患者进行的193例PIPAC手术。丙泊酚（100%）、罗库溴铵（98%）、预防性使用止吐药（99%）和静脉注射利多卡因（87%）的方案依从性较高。研究期间未发生化疗药物的意外暴露。87例患者中，6.3%出现恢复延迟，其中58%是由于体温过低，42%是由于镇静或肌松过度。在恢复室，16%的患者出现中度至重度疼痛，需要静脉注射>8 mg吗啡，平均剂量为13.7 mg。术后静息和活动时12小时的疼痛评分中位数分别为1和3，72小时时分别为0和0。在前12小时内，<10%的患者出现PONV，但在72小时时为40%。
专门的麻醉方案和术中安全检查表有助于为PIPAC治疗提供安全且耐受性良好的麻醉。
