Anesthesia-specific Protocol for Percutaneous Hepatic Perfusion Procedures.

Percutaneous hepatic perfusion (PHP) procedures are being increasingly utilized to treat metastatic liver disease from uveal melanoma. The authors' institution has more than 15 years of experience with over 200 PHP procedures performed, far surpassing any other center in the United States. The anesthetic safety profile for PHP procedures is favorable and begins with preoperative patient evaluation and optimization. Intraoperative anesthetic management can be challenging, with extreme fluctuations seen in blood pressure and heart rate associated with direct hepatic artery chemotherapy delivery and the venovenous bypass circuit. Patients often need maximal doses of vasopressors for a short time period to treat these hemodynamic disturbances. Postoperatively, patients require a variety of blood products to resolve coagulopathy and may need diuretics to treat fluid overload. Anesthesia- and procedure-associated complications are rare and include anaphylaxis, arrhythmias, cardiac ischemia, pulmonary edema, and bleeding. PHP procedures are generally well-tolerated, and an anesthesia-specific protocol is imperative for their success.