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Canadian Journal of Anesthesia, Vol 31, 552-558, Copyright © 1984 by Canadian Anesthesiologists' Society

Clinical Reports: Isolated Regional Perfusion; Anaesthetic Technique, Monitoring and Blood Replacement

MICHAEL E. GOLDBERG MD1, HARRY M. ROSENBLUM MD1, JOSEPH L. SELTZER MD1, and FRANCIS E. ROSATO MD1

1 Departments of Anesthesiology and Surgery Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania

Address correspondence to: Dr. Michael E. Goldberg, c/o Department of Anesthesiology, Thomas Jefferson University Hospital, 111 S. 1 lth Street, Suite 6275, Philadelphia, Pennsylvania 19107.

Isolated regional perfusion for the treatment of malignant melanoma is an accepted method of treatment. No standard of anaesthetic practice has been established for those individuals. Perioperative records of patients undergoing isolated limb perfusion were studied to determine adequate blood replacement. Records were examined and compared for (1) age, (2) ASA physical status, (3) presence of associated disease, (4) anaesthetic technique, (5) the amount of blood and fluid replacement, (6) preoperative haemoglobin (hgb) and haematocrit (hct) and postoperative serial complete blood counts. Fifteen patients were studied (mean age 53 ± 16 yrs). Mean blood and fluid replacement was: packed red blood cells; 2.28 ± 0.82 units, 722 ± 17 ml of 5 per cent albumin, 1747 ± 21 ml crystalloid. There were twelve Physical Status Class I or II and three Class III patients. All patients received general anaesthesia. There was a statistically significant difference in the preoperative and postoperative values for haemoglobin and haematocrit (p < 0.01) with no difference between the postoperative and discharge values. Adequate blood replacement was determined by the equation:

Washout hct x volume of washout / Patient's preop hct = ml of blood lost

Extensive invasive monitoring is not routinely required for adequate blood replacement or the detection of leaks between the systemic and isolated circulation.

Key Words: SURGERY: isolated regional perfusion • MONITORING: fluid replacement, haemodilution • ANAES-THETIC TECHNIQUE: isolated regional perfusion






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Copyright © 1984 by the Canadian Anesthesiologists' Society.