A prospective randomized comparison between passive hypothermia and normothermia before starting HIPEC on rebound hypothermia after intraperitoneal hyperthermic chemotherapy

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is an established treatment modality for peritoneal tumors, both primary and metastatic in origin. The peri-operative period is marked with varying blood loss, hemodynamic, and temperature fluctuations, electrolyte and acid-base imbalances and coagulation abnormalities and can be a challenge for perioperative physicians. In addition, during the HIPEC phase, these patients are treated with heated chemotherapeutic agents instilled in the abdominal cavity, predisposing them to the deleterious effects of hyperthermia along with the potential toxicity of the chemotherapeutic drugs. [4,5] Normothermia maintenance is an important goal in perioperative period in patients undergoing CRS and HIPEC.

In another study, it was seen that the core temperature significantly decreased after the cytoreductive surgery and before HIPEC than the baseline (33.5°C ± 1.7°C and 36.5°C ± 0.6°C, respectively), then significantly increased during HIPEC (38.2°C ± 1.1°C) and persisted after completion (38°C ± 0.8°C) than before this phase. In the study appearing in this issue, in patients undergoing CRS and HIPEC, the authors reported that higher delta temperature was associated with a longer duration of ventilation and intensive care unit stay.

Perioperative hypothermia poses significant clinical implications of its own, leading to a threefold increase in incidence of adverse myocardial events. It has been hypothesized that hypothermia induced hypertension increases plasma norepinephrine levels in the elderly which can increase cardiac irritability and predispose the patient to develop ventricular arrythmias. Rebound hypothermia after HIPEC can cause serious life threatening complications.

In addition, there is a significant increase in blood loss and blood transfusion requirement, coagulopathies, wound infection, chances of prolonged post-operative recovery, and mild hypokalemia. [8,10] Literature is limited about the effects of immediate post-operative hypothermia on patients undergoing major surgical procedures such as CRS-HIPEC and their effect on the derranged internal milieu as indicated by the hemodynamic instability encountered.