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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2007 June;73(6):333-7
Anesthetic techniques and complications in patients with hepatocellular carcinoma undergoing percutaneous ethanol injection
Nimmaanrat S. 1, Prechawai C. 1, Tanomkiat W. 2
1 Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand;
2 Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
Aim. The aim of this study was to analyze anesthetic techniques and complications found in patients with hepatocellular carcinoma (HCC) who have undergone percutaneous ethanol injection (PEI).
Methods. A retrospective study was performed on 67 patients with HCC who underwent 120 sessions of ultrasound-guided PEI between January 2004 and April 2006.
Results. The mean age of the patients was 56.4 (25-77) years. Males accounted for the majority of the patients (75%). The ASA classifications were from ASA class I (2.5%), class II (82.5%), and class III (15%). Premedication with benzodiazepines was given to 68.3% of the patients. In 81.7% of the procedures, the patients received total intravenous anesthesia with 13.3%, 4.2%, and 0.8% undergoing general anesthesia with either an endotracheal tube, general anesthesia with mask, or monitored anesthesia care, respectively. Most (95.8%) patients were given propofol. Thiopental and ketamine (1.7% each) were used as an induction agent. In only 0.8% of the sessions did the patient receive morphine as an intraprocedural analgesic, while 99.2% of the sessions received fentanyl. Isoflurane was delivered to all of the patients receiving general anesthesia. Bradycardia, hypotension, bradycardia plus hypotension and hypotension plus hypoxemia occurred in 0.8%, 6%, 0.8% and 0.8% of the sessions, respectively. A single patient (1.5% of the patients or 0.8% of the sessions) had cardiovascular collapse during the procedure. The mean duration of anesthesia was 34.7 (10-105) min and the patients were observed in a recovery room for a mean duration of 51.7 (0-175) min. The majority of the recovery room admissions (89.2%) did not have any complications. A minority of the cases (9.2%) received fentanyl in the recovery room as a means of pain management.
Conclusion. Various kinds of anesthesia are suitable for patients with HCC scheduled for ultrasound-guided PEI. Although PEI is not commonly associated with serious complications, it is not entirely risk-free and careful monitoring and prompt resuscitation are essential for the safety of the patients as the procedure is performed in an interventional radiology suite, which is considered to be a remote area.