Isolated limb perfusion is a surgical technique which allows high-dose chemotherapy to be delivered to a limb. Typically used to treat locally invasive malignant melanoma.
Suggested anaesthetic management of ILP to a lower limb:
The patient should be crossmatched for 4u.
1) Approx 1 hour. The circulation is isolated by cannulation of the iliac vessels. A general anaesthetic is appropriate, with direct arterial monitoring. Moderate fluid preload is appropriate following induction.
2) The patient is fully anticoagulated prior to the local extra-corporeal circulation. Heparin 300u/kg to an ACT (haemacron) > 400s. Inotropes may be needed to support the bp during the establishment of the perfusion circuit. Normally, a blood containing prime is used.
3) Approx 45 minutes of limb perfusion with high-dose chemotherapy. Little stimulation of the patient during this, bp should be kept higher than the bypass pressures to help prevent systemic contamination from the limb. Fluoroscein may be injected into the limb, and fluorescence sought from proximal tissues as evidence of systemic leakage.
4) After 45 mins of limb perfusion, the ILP is discontinued, the patient is decannulated, and anticoagulation fully reversed with protamine. Hb is checked post-operatively, and patient transfused if required.
