EVALUATION OF CARDIOVASCULAR EVENTS WITH PRO BNP CKMB AND TROPONIN IN PATIENTS WITH HYPERTERMIC INTRAPERITONEAL CHEMOTHERAPY
Project no. 20162 · Status: Kapanmış (Yayın bekleniyor) · 2018
Summary
PURPOSE: Cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) procedure has been applied increasingly often to patients with peritoneal carcinamatosis due to its positive effects on survival. The hemodynamic and metabolic instability in this procedure complicates the application of anesthesia. Peroperative practises' effects on mortality and morbidity are not clear. In our study, we proposed to examine how specifically myocard is affected from this procedure. Therefore, the first purpose of this study is to determine the causes of the presence of myocardial function impairment using the CK-MB, NT-ProBNP, Troponin-T levels; secondarily is to determine the relation between the myocardial functions and peroperative anesthesia practises. This relation will channel the optimal anesthesia practises on CRS an HIPEC surgeries. METHOD: Our study is planned as cross-sectional, prospective and cohort. With the consent of the Clinical Research Ethics Committee, the patients who underwent a CRS-HIPEC surgery between January 2018-September 2019 were included in the study. Except the standard inhalation anesthesia and invasive monitorization, the pro-BNP, CK-MB and troponin-t and routine biochemical tests and hemogram levels at preoperative period and postoperative 6th hour were determined. Patients are separated into two different groups acccording to the demand for norepinephrine intraoperatively. Kolmogorov-Smirnow, Shapiro Wilk, Mann-Whitney, Fisher, Wilcoxon and Spearman’s tests are used for statistical analysis. FINDINGS: Due to withdrawal from the HIPEC procedure 8 of the 38 patients were excluded from the study, 30 patients are evaluated statistically. Patients were 54 (±10) years old, 165 (±10) cm length, 72 (±12) kg body weight; female/male 12/18. ASA Scores distribution were 8/21/1(I/II/III). There was no significant difference in demographic properties between the groups. The mean time for anesthesia was 432 (±122) minutes, for operation 394 (±125) minutes, for SRC was 264 (±111) minutes, for HIPEC was 64 (±32) minutes. . The norepinephrine required group's (n=14) anesthesia times and SRC times, erytrocyte suspension requirement and renal complication rate were statistically significantly higher than the non- NE required group (n=16)(p<0,05). Crystalloid and colloid volumes used, mortality rate and hemodynamic course were similar in groups (p>0,05). Blood pressure and heart rates significantly decreased in both groups in the process of time (p<0,05). Postoperative NT-ProBNP, Troponin-T and CK-MB mass levels significantly increased according to preoperative period. When the preoperative-postoperative enzyme levels compared, Nt-proBNP and CK-MB mass have been observed to increase significantly in both groups, but the Troponin-T level increased significantly only in the NE-required group. However, postoperative Troponin-T level and the difference between postopreative-preoperative levels had found to be significantly related to the time of CRS and hospitalization times. Postoperative CK-MB level and the level difference between postoperative-preoperative periods were significiantly related witg anesthesia and operation times. RESULT: The Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy are complex surgery practises that require vasoconstructor agents because of the hemodynamic instability. Considering enzyme levels changes, perioperative hemodynamic instability may refer to myocardial damage. However, this evidence needs to be justified by further studies that implemented with larger patients series.