Anesthesia for isolated hyperthermic limb perfusion

Regional recurrences of malignant melanoma remain difficult to effectively treat. Creech et al. originated the use of isolated regional perfusion of the involved extremity withh melphalan (1-phenylalanine mustard), utilizing an extracorporeal circuit to obtain the highest possible concentration of this drug at the metastatic sites with minimal systemic toxicity. Hyperthermia was added to this therapy because of the possible beneficial effects of heat on tumors. Isolated regional perfusion with extracorporeal circulation, chemotherapy, and hyperthermia is not without complication. Mortality figures range from 0.8 to 3% for the procedure, with deaths reported from myocardial infarction, renal failure, pulmonary embolus, congestive heart failure, and massive hemorrhage. The authors describe the anesthetic management of two patients undergoing isolated leg perfusion and suggest precautions available to limit complications.