A pilot randomised clinical trial comparing desflurane anaesthesia vs total intravenous anaesthesia, for changes in haemodynamic, inflammatory and coagulation parameters in patients undergoing hyperthermic intraperitoneal chemotherapy

Anuja Pandit; Vishwajeet Singh; Sachidanand J Bharati; Seema Mishra; Suryanarayana Vs Deo; Sushma Bhatnagar

doi:10.4103/ija.IJA_34_20

A pilot randomised clinical trial comparing desflurane anaesthesia vs total intravenous anaesthesia, for changes in haemodynamic, inflammatory and coagulation parameters in patients undergoing hyperthermic intraperitoneal chemotherapy

Indian J Anaesth. 2020 Aug;64(8):688-695. doi: 10.4103/ija.IJA_34_20. Epub 2020 Jul 31.

Authors

Anuja Pandit¹, Vishwajeet Singh², Sachidanand J Bharati³, Seema Mishra³, Suryanarayana Vs Deo⁴, Sushma Bhatnagar³

Affiliations

¹ Department of Onco-Anaesthesia and Palliative Medicine, National Cancer Institute, All India Institute of Medical Sciences, New Delhi, India.
² Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
³ Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
⁴ Department of Surgical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.

Abstract

Background and aims: Cytoreduction and hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) cause numerous pathophysiological changes. The objective of this study was to compare the effect of two anaesthetic techniques on haemodynamic changes, inflammatory and coagulation parameters during this procedure.

Methods: Twenty-one consenting adults undergoing CRS+HIPEC procedure, were block randomised to receive desflurane (V, n = 9) or TIVA (T, n = 12). After epidural catheter placement and intravenous induction of anaesthesia in both groups with fentanyl, propofol and rocuronium, anaesthesia was maintained with propofol or with desflurane, based on group allocation. Haemodynamic and temperature changes were assessed intra-operatively and variance was analysed. Inflammatory and coagulation markers were measured and compared at five time-points in the peri-operative period. Categorical variables were analysed using Chi square or Fisher exact test. Continuous variables were compared using t-test or Wilcoxon rank sum test.

Results: Changes in core body temperature and haemodynamic variables during the hyperthermic intraperitoneal chemotherapy (HIPEC) phase were comparable between the two groups; except mean variance of mean arterial pressure, which was significantly higher (P = 0.0056) in group V (receiving desflurane) (58.98 ± 36.74) than TIVA group (27.51 ± 14.22). Inflammatory markers in both groups were comparable at five defined time points in the peri-operative period. On post-hoc analysis, pairwise comparisons with baseline, between levels of inflammatory markers within each group showed increased post-operative inflammation in group V. Mean prothrombin time was comparable.

Conclusion: Desflurane group suffered greater mean arterial pressure (MAP) instability during the HIPEC phase. Inflammation in both groups was highest during the first 24 h after surgery. Prolonged inflammation was noted in patients receiving desflurane.

Keywords: Desflurane; hyperthermic intraperitoneal chemotherapy; induced hyperthermia; inflammation; propofol; temperature.