Desflurane as a marker of limb-to-systemic leak during hyperthermic isolated limb perfusion.

SOME malignancies of the extremities can be treated by hyperthermic isolated limb chemotherapy. This procedure involves arterial and venous cannulation of the affected limb and isolated perfusion using a bypass pump. When a steady state is reached, the blood is warmed and oxygenated, and a chemotherapeutic agent (e.g., melphalan) is added and circulated in the limb for up to 1 h. Because the limb is theoretically isolated, large doses of the chemotherapeutic drugs may be used, sometimes as much as 10 times a systemic dose. However, there is an ever-present danger of leak from the limb to the rest of the body. This is termed a “systemic leak,” and it is potentially hazardous to the patient. The continued integrity of limb isolation during the bypass period is therefore critical. Various methods of limb isolation have been described, ranging from tourniquet occlusion to more sophisticated systemic or limb flow and pressure manipulations. Regardless of the technique, monitoring for a leak in real-time has proved to be difficult. We describe a new technique to monitor for limb-to-systemic leak during hyperthermic isolated limb chemotherapy. Case Report