Abstract
Background: Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is a novel minimally invasive technique for the treatment of peritoneal carcinomatosis that allows localized delivery of cytotoxic drugs under pressure. Despite its clinical potential, this procedure presents unique anesthetic challenges due to increased intra-abdominal pressure, limited access to the patient during aerosolization, and the need for strict safety measures to prevent occupational exposure. Objective: The objective of this study was to evaluate the specific features of anesthetic management during Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) procedures and to determine the safety and tolerability of this method. Methods: This retrospective analysis included 26 PIPAC procedures performed under general anesthesia. The study focused on parameters related to anesthesia induction, mechanical ventilation, depth of neuromuscular blockade, integrity of the breathing system, and intraoperative monitoring. Given the unique conditions of PIPAC, such as increased intra-abdominal pressure, limited access to the patient during the procedure, and the risk of occupational exposure to aerosolized cytotoxic agents, anesthetic management was tailored accordingly. Particular attention was paid to ensuring an airtight respiratory circuit, preventing aerosol leakage, and controlling carbon dioxide levels throughout the procedure. Results: All patients received adequate general anesthesia with stable hemodynamic and respiratory parameters throughout the procedure. No major anesthesia-related complications were observed. The procedure was well tolerated by all patients. Effective neuromuscular blockade was achieved in each case to facilitate laparoscopic access and ensure immobility during the aerosol chemotherapy phase. End-tidal carbon dioxide levels were closely monitored, and hypercapnia was successfully controlled through ventilatory adjustments. The use of a closed anesthetic circuit and appropriate filtration systems ensured both patient and staff safety by minimizing aerosol exposure. Conclusion: PIPAC is a safe and well-tolerated procedure when performed with adherence to specific anesthetic requirements. Successful anesthetic management includes deep neuromuscular blockade, advanced monitoring, strict respiratory circuit integrity, and readiness to manage potential hypercapnia. There is a clear need to develop and implement standardized anesthetic protocols for PIPAC procedures in order to optimize clinical outcomes and minimize associated risks.