Hyperthermic Intraperitoneal Chemotherapy

Malignant Hyperthermia is a life-threatening, genetic disorder that involves the skeletal muscles. It commonly occurs intraoperatively and postoperatively when inhalant agents such as halothane, enflurane, and isoflurane are used, as well as some muscle relaxants such as succinylcholine and curare. It

Malignant Hyperthermia is primarily thought to be an autosomal dominant genetic disorder that causes a hypermetabolic state after administration of volatile anesthetics. When a patient is under anesthesia, the muscles are usually relaxed, but when a patient is experiencing Malignant Hyperthermia crisis, certain IV anesthesia causes the opposite effect. Most inhaled anesthetics other than nitrous oxide, cause or trigger Malignant Hyperthermia. More specifically, the anesthetic agents: Halothane, Chloroform, and Succinylcholine. The genic condition of Malignant Hyperthermia only becomes apparent when a patient is exposed to certain anesthetics such as halothane, which causes muscle rigidity.

Surgery is the oldest type of treatment for cancer. In its earlier use, surgery was not as successful as it is today. This was due to the difficulties involved with the anesthesias, excessive blood loss,

Melling, Baqar, Eileen & David (2001), knew that warming patients during colorectal surgery had shown to reduce infection rates. In their study, they wanted to

Malignant hyperthermia may not show itself during the first surgery. Yet, during future surgeries the risk remains. In some rare occurrences, people with the condition have shown signs of a reaction after intense exercise. The surgeon and anesthesiologist should be notified prior to surgery if the patient has been diagnosed with malignant hyperthermia so that they can be prepared to treat the reaction if it should occur. Treatment consists of a drug called dantrolene (Dantrium). Dantrolene is a skeletal muscle relaxant. It is indicated for the prophylaxis treatment of malignant hyperthermia. It acts directly on skeletal muscle, causing relaxation by decreasing calcium release from sarcoplasmic reticulum in muscle cells. It also prevents the intense catabolic process associated with the condition. The dosage indicated for adults by PO is 4-8 mg/kg/day in 3-4 divided doses for 1-2 days before the procedure, the last dose is to be given 3-4 hours preoperative. The dosage for adults during a post-hyperthermic crisis follow-up is 4-8 mg/kg/day PO in 3-4 divided doses for

• Electrodesiccation and curettage. This involves alternately scraping and burning the tumor, using an electric current to control bleeding.

The cyst cavity is irrigated with normal saline. Cyst wall epithelium is destroyed by laser vaporization. Large endometrioma (> 4 cm) is often associated with extensive adhesion to other pelvic structures. Laparoscopy is necessary for ovarian cystectomy and adhesiolysis.

Clinical Trials: In patients with metastatic colorectal cancer, in combination with fluorouracil/folinic acid, Oxaliplatin showed its activity against metastatic colorectal, both as a first-line therapy and in patients refractory to previous chemotherapy. In addition, oxaliplatin has also shown efficacy in patients with platinum-pretreated ovarian cancer, non-Hodgkin's lymphoma, breast cancer, mesothelioma and non-small cell lung

This technique is best suited overall to small tumours (less than 3cm) deep within the hepatic parenchyma and away from the hepatic hilum (Bartlett et al., 2005).

Radiofrequency ablation: This technique uses heat to destroy cancer cells. The physician guides a probe containing tiny electrodes through the skin into the tumor using imaging techniques, such as CT, MRI, or ultrasound. The heat generated by the electrodes destroys the cancer cells. Generally, only a local anesthetic is required for this procedure. In some cases, the physician may insert the probe through a cut in the abdomen using a laparoscope. This procedure requires general anesthesia.

According to the National Cancer Institute, cryosurgery is the use of extreme cold produced by liquid nitrogen to destroy abnormal tissue (National Cancer Institute, 2013). Cryosurgery is generally used to treat external tumors, but may also be used to treat tumors that form internally. Cryosurgery is a cheap and effective treatment that can be done at both hospital and office based practices.

De-livering an outcome hard to digest: The acceptable toxicity level of new chemotherapeutic regimen in treating metastatic colorectal cancer may improve liver resections.

Abstract; Malignant hyperthermia is rare inherited disorder in our part of world, there are only few cases reported in literature in India who were suspected of having this condition. Overall incidence of malignant hyperthermia during general anesthesia is estimated to range from 1: 5,000 to 1: 50,000-100,000 and mortality rate is estimated to be less than 5% in presence of standard care. In India there is no centre where invitro halothane caffeine contraction test (IVHCT) is performed to confirm diagnosis in suspected cases. Secondly dantrolene drug of choice for this condition is not freely available in market in India and is stored only in some hospitals in few major cities. Among the cases reported of suspected of malignant hyperthermia in India almost 50% have survived the condition despite non availability of dantrolene emphasising role of early detection and aggressive management in these cases.

For decades, liquid air, carbonic snow and iced saline solutions were used to destroy advance malignancies for palliative purposes [5]. Now, there is a significantly increasing demand for novel, minimally invasive treatments as the need for tumour detection rises. When surgery is not feasible, other therapeutic alternatives including chemotherapy, thermal ablation, systemic therapies and intra-arterial interventions are used [6]. Unfortunately, no systemic therapy has been proven effective. While chemotherapy and RFA have shown to relieve pain, decrease liver size and improve liver function tests, it also affects the normal liver as well as tumorous tissues, limiting their usefulness [5]. CA which is based on the non-toxic nature of cold

Studies show that patients with metastatic colorectal cancer clearly prefer oral to intravenous therapy [7, 8], primarily due to convenience, toxicity considerations [7], problems with intravenous lines, and a better environment for administration. [5]