Percutaneous hepatic melphalan perfusion: Single center experience of procedural characteristics, hemodynamic response, complications, and postoperative recovery.

<h4>Background</h4>Percutaneous hepatic melphalan perfusion (PHMP) for the selective treatment of hepatic metastases is known to be associated with procedural hypotension and coagulation disorders. Studies on anesthetic management, perioperative course, complications, and postoperative r...

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Autores principales:	Manuel Florian Struck, Peter Kliem, Sebastian Ebel, Alice Bauer, Holger Gössmann, Rhea Veelken, Florian van Bömmel, Timm Dennecke, Sebastian N Stehr, Felix F Girrbach
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/da2fd030c8994fa3a9253011c037c514
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spelling	oai:doaj.org-article:da2fd030c8994fa3a9253011c037c5142021-12-02T20:09:08ZPercutaneous hepatic melphalan perfusion: Single center experience of procedural characteristics, hemodynamic response, complications, and postoperative recovery.1932-620310.1371/journal.pone.0254817https://doaj.org/article/da2fd030c8994fa3a9253011c037c5142021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0254817https://doaj.org/toc/1932-6203<h4>Background</h4>Percutaneous hepatic melphalan perfusion (PHMP) for the selective treatment of hepatic metastases is known to be associated with procedural hypotension and coagulation disorders. Studies on anesthetic management, perioperative course, complications, and postoperative recovery in the intensive care unit (ICU) have not been published.<h4>Methods</h4>In a retrospective observational study, we analyzed consecutive patients who were admitted for PHMP over a 6-year period (2016-2021). Analyses included demographic, treatment, and outcome data with regard to short-term complications until ICU discharge.<h4>Results</h4>Fifty-three PHMP procedures of 16 patients were analyzed. In all of the cases, procedure-related hypotension required the median (range) highest noradrenaline infusion rate of 0.5 (0.17-2.1) μg kg min-1 and fluid resuscitation volume of 5 (3-14) liters. Eighty-four PHMP-related complications were observed in 33 cases (62%), of which 9 cases (27%) involved grade III and IV complications. Complications included airway constriction (requiring difficult airway management), vascular catheterization issues (which resulted in the premature termination of PHMP, as well as to the postponement of PHMP and to the performance of endovascular bleeding control after PHMP), and renal failure that required hemodialysis. Discharge from the ICU was possible after one day in most cases (n = 45; 85%); however, in 12 cases (23%), prolonged mechanical ventilation was required. There were no procedure-related fatalities.<h4>Conclusions</h4>PHMP is frequently associated with challenging cardiovascular conditions and complications that require profound anesthetic skills. For safety reasons, PHMP should only be performed in specialized centers that provide high-level hospital infrastructures and interdisciplinary expertise.Manuel Florian StruckPeter KliemSebastian EbelAlice BauerHolger GössmannRhea VeelkenFlorian van BömmelTimm DenneckeSebastian N StehrFelix F GirrbachPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0254817 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Manuel Florian Struck Peter Kliem Sebastian Ebel Alice Bauer Holger Gössmann Rhea Veelken Florian van Bömmel Timm Dennecke Sebastian N Stehr Felix F Girrbach Percutaneous hepatic melphalan perfusion: Single center experience of procedural characteristics, hemodynamic response, complications, and postoperative recovery.
description	<h4>Background</h4>Percutaneous hepatic melphalan perfusion (PHMP) for the selective treatment of hepatic metastases is known to be associated with procedural hypotension and coagulation disorders. Studies on anesthetic management, perioperative course, complications, and postoperative recovery in the intensive care unit (ICU) have not been published.<h4>Methods</h4>In a retrospective observational study, we analyzed consecutive patients who were admitted for PHMP over a 6-year period (2016-2021). Analyses included demographic, treatment, and outcome data with regard to short-term complications until ICU discharge.<h4>Results</h4>Fifty-three PHMP procedures of 16 patients were analyzed. In all of the cases, procedure-related hypotension required the median (range) highest noradrenaline infusion rate of 0.5 (0.17-2.1) μg kg min-1 and fluid resuscitation volume of 5 (3-14) liters. Eighty-four PHMP-related complications were observed in 33 cases (62%), of which 9 cases (27%) involved grade III and IV complications. Complications included airway constriction (requiring difficult airway management), vascular catheterization issues (which resulted in the premature termination of PHMP, as well as to the postponement of PHMP and to the performance of endovascular bleeding control after PHMP), and renal failure that required hemodialysis. Discharge from the ICU was possible after one day in most cases (n = 45; 85%); however, in 12 cases (23%), prolonged mechanical ventilation was required. There were no procedure-related fatalities.<h4>Conclusions</h4>PHMP is frequently associated with challenging cardiovascular conditions and complications that require profound anesthetic skills. For safety reasons, PHMP should only be performed in specialized centers that provide high-level hospital infrastructures and interdisciplinary expertise.
format	article
author	Manuel Florian Struck Peter Kliem Sebastian Ebel Alice Bauer Holger Gössmann Rhea Veelken Florian van Bömmel Timm Dennecke Sebastian N Stehr Felix F Girrbach
author_facet	Manuel Florian Struck Peter Kliem Sebastian Ebel Alice Bauer Holger Gössmann Rhea Veelken Florian van Bömmel Timm Dennecke Sebastian N Stehr Felix F Girrbach
author_sort	Manuel Florian Struck
title	Percutaneous hepatic melphalan perfusion: Single center experience of procedural characteristics, hemodynamic response, complications, and postoperative recovery.
title_short	Percutaneous hepatic melphalan perfusion: Single center experience of procedural characteristics, hemodynamic response, complications, and postoperative recovery.
title_full	Percutaneous hepatic melphalan perfusion: Single center experience of procedural characteristics, hemodynamic response, complications, and postoperative recovery.
title_fullStr	Percutaneous hepatic melphalan perfusion: Single center experience of procedural characteristics, hemodynamic response, complications, and postoperative recovery.
title_full_unstemmed	Percutaneous hepatic melphalan perfusion: Single center experience of procedural characteristics, hemodynamic response, complications, and postoperative recovery.
title_sort	percutaneous hepatic melphalan perfusion: single center experience of procedural characteristics, hemodynamic response, complications, and postoperative recovery.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/da2fd030c8994fa3a9253011c037c514
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Percutaneous hepatic melphalan perfusion: Single center experience of procedural characteristics, hemodynamic response, complications, and postoperative recovery.

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