Abstract:
STUDY OBJECTIVE:To evaluate the safety and efficacy of monitored anesthesia care (MAC) in patients who undergo a novel treatment for hepatocellular cancer in which procedure-related hemodynamic instability is problematic. DESIGN:Nonrandomized open study. SETTING:University cancer center operating room. PATIENTS:Nine patients scheduled for hepatic arterial infusion of doxorubicin with complete hepatic venous isolation and extracorporeal chemofiltration (no more than 3 procedures per patient). INTERVENTIONS:Hepatic venous isolation was achieved with a dual-balloon inferior vena cava catheter connected to an extracorporeal circuit containing chemofilters. Doxorubicin was infused through the hepatic artery and filtered from the venous blood, which was returned to the patient through an internal jugular venous catheter. Each patient received a bolus of propofol (200 micrograms/kg) and one of alfentanil (2 micrograms/kg) followed by simultaneous infusions of propofol and alfentanil for percutaneous placement of the catheters and operation of the extracorporeal circuit. Drug rates were varied to maintain a sedative-analgesic state of calm, comfort, minimal movement, and adequate respiratory function. Prior to circuit initiation, patients were preloaded with crystalloid. During circuit operation, hypotension was treated with intravenous (IV) phenylephrine and crystalloid. MEASUREMENTS AND MAIN RESULTS:End-tidal CO2 (PETCO2), respiratory rate, oxygen saturation (SaO2), arterial blood pressure (BP), and heart rate (HR) were monitored. Systolic, diastolic, and mean arterial pressure (MAP), and HR were compared before, during, and after hepatic venous isolation and chemofiltration. Doses and infusion rates of propofol, alfentanil, and phenylephrine were recorded for each treatment. Hypotension occurred in 11 of 13 procedures when blood was directed through the chemofilters and was successfully treated with phenylephrine (dose range 40 to 5,733 micrograms) and crystalloid. Blood pressure returned to the baseline value on termination of the circuit. Throughout the sedation, patients were easily arousable, analgesia was adequate, and PETCO2 level of 38 +/- 4 mmHg and SaO2 greater than 94% were maintained. Mean doses and infusion rates of MAC drugs were, respectively: propofol, 261 +/- 88 mg and 23.7 +/- 3.6 micrograms/kg/min; alfentanil, 3,350 +/- 1,468 micrograms and 0.32 +/- 0.14 microgram/kg/min. CONCLUSIONS:Patients undergoing this novel cancer treatment are safely and effectively managed by MAC achieved with simultaneous infusions of alfentanil and propofol. Procedure-associated hypotension is easily treated with IV phenylephrine and crystalloid.
journal_name
J Clin Anesthjournal_title
Journal of clinical anesthesiaauthors
Dougherty TB,Mikolajek JA,Curley SAdoi
10.1016/s0952-8180(97)00031-7subject
Has Abstractpub_date
1997-05-01 00:00:00pages
220-7issue
3eissn
0952-8180issn
1873-4529pii
S0952-8180(97)00031-7journal_volume
9pub_type
临床试验,杂志文章abstract::A case of a 49 year old man with a giant basilar artery aneurysm requiring rapid ventricular pacing is presented. Rapid ventricular pacing decreased aneurysm size and increased operative exposure, which aided surgical decision making. It also provided decreased wall tension in the aneurysm. ...
journal_title:Journal of clinical anesthesia
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abstract:STUDY OBJECTIVE:To compare turnover times for a series of elective cases with surgeons following themselves with turnover times for a series of previously scheduled elective procedures for which the succeeding surgeon differed from the preceding surgeon. DESIGN:Retrospective cohort study. SETTING:University-affiliate...
journal_title:Journal of clinical anesthesia
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journal_title:Journal of clinical anesthesia
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journal_title:Journal of clinical anesthesia
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journal_title:Journal of clinical anesthesia
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journal_title:Journal of clinical anesthesia
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doi:10.1016/s0952-8180(98)00037-3
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journal_title:Journal of clinical anesthesia
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journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
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