Anesthesia management of the patients with various malignancies undergoing whole body hyperthermia / 中华麻醉学杂志

ABSTRACT

Twenty-six total intravenous anesthesia was performed in 23 ASAⅡorⅢpatients with various advanced malignancies undergoing whole body hyperthermia (WBH). Their age ranged from 32 to 67 yrs and body weight between 42 and 77 kg. The patients had no hypertension, coronary artery disease or diabetes mellitus. Anesthesia was induced with midazolam 5-10 mg, fentanyl 0.1 mg, propofol 1.5-2.5 mg?kg-1 and vecuronium 0.12 mg?kg-1 and maintained withⅣinfusion of midazolam (0.08-0.16 mg?kg-1?h-1), remifentanil (0.05-0.15?g?kg-1?h-1) and vecuronium (0.08-0.15 mg?kg-1?h-1). The patients were mechanically ventilated (VT = 8-12 ml?kg-1, RR= 10-18 bpm, FiO2 = 1.0) after tracheal intubation. PETCO2 was maintained at 35 mm Hg. ECG, MAP, HR, CVP, SpO2 , PETCO2 , peak airway pressure, VT, RR, minute ventilation (MV), urine output, core temperature (lower esophageal and naso-pharyngeal) and surface temperature were continuously monitored. Swan-Ganz catheter was placed in 15 patients. MPAP, PCWP and cardiac output (CO) were measured and Qs/Qt, cardiac index (CI) and stroke index (SI) were calculated. WBH was induced in an ultra-red radiation hyperthermic cabin (type ET-SpaceTM-1) and was divided into 3 phasesⅠwarming phase (lower esophageal temperature increased gradually to 41.8℃) ;Ⅱhyperthermic phase (lower esophageal temperature was maintained at 41.8℃for 1 h) andⅢcooling phase (core temperature was gradually decreased to 38.5℃without any cooling measures). Blood samples were taken from artery and Swan-Ganz catheter 15 min after induction of anesthesia (baseline), at 39℃, 40℃, 41℃and 41.8℃during warming phase, at the late hyperthermic phase and at 40℃and 38.5℃during cooling phase for blood gas analysis, determination of blood electrolytes and sugar. As the temperature was increasing, HR, CI, SI, CVP, MPAP, PCWP, Qs/Qt and peak airway pressure were gradually increased while MAP, PaO2 , pHa, BE and blood glucose and K+ were decreasing during warming phase (Ⅰ). These changes reached the peak levels at the late period of hyperthermic phase (Ⅱ) and then gradually returned to baseline during cooling phase (Ⅲ) . Vasoactive drugs and fluid infusion including crystalloid and colloid were needed to maintain hemodynamic stability in 69% patients. Acidosis had to be corrected in 54% patients. Severe hypotension and pulmonary edema occurred in 4 patients. Continuous hemodynamic monitoring, respiratory support, maintenance of circulatory stability and correction of acidosis and hypokalemia were the key factors in the management of patients during WBH.