Hyperthermic Intraperitoneal Chemotherapy In A Multiple Sclerosis Patient

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Medically Challenging Case Report Poster 


Janet Hong  
Mount Sinai West and Mount Sinai St. Luke's Hospitals


Jonathan Epstein  
Mount Sinai West and Mount Sinai St. Luke's Hospitals


Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is being increasingly performed as a treatment modality for gastrointestinal tract or gynecological neoplasms that evolve to peritoneal carcinomatosis. This major abdominal surgery involves infusing chemotherapy heated to 42°C-43°C into the peritoneal cavity for local control of the disease, which minimizes the effects of systemic toxicity but results in marked physiological changes due to the temperature and large-volume fluid shifts. We present an interesting case of a 62-year-old female with Multiple Sclerosis that is well controlled, not requiring medical therapy, and perforated appendiceal mucinous neoplasm presenting for laparoscopic debulking of the peritoneal tumor and hyperthermic intraperitoneal chemotherapy (HIPEC). Multiple sclerosis (MS) is a progressive neurological disorder that disrupts axonal myelin in the central nervous system and affects at least 2.5 million people worldwide. In addition to the stress of surgery, any increase in body temperature, even as little as 1°C, can cause an exacerbation of MS. Clinical manifestations of MS exacerbation depend on the sites affected but frequently include sensory disturbances (paresthesias), visual problems (optic neuritis and diplopia), and motor weakness. Therefore, anesthesiologists who encounter MS patients undergoing CRS and HIPEC must provide counsel to the effect that the surgical and thermal stress might exacerbate symptoms, maintain normothermia with proper attention and vigilance intraoperatively, and ensure periodic neurologic evaluation postoperatively in an acute care setting for detection of disease exacerbation.

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Enter up to two references.

1. Scott L. Davis, Thad E. Wilson, Andrea T. White, and Elliot M. Frohman. Thermoregulation in multiple sclerosis. Journal of Applied Physiology 2010 109:5, 1531-1537
2. Sheshadri DB, Chakravarthy MR. Anaesthetic Considerations in the Perioperative Management of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Indian J Surg Oncol. 2016;7(2):236–243. doi:10.1007/s13193-016-0508-2