Anesthetic Management, Complications, and Postprocedural Pain in Patients Undergoing Percutaneous Irreversible Electroporation (IRE) in Siriraj Hospital: A Case Series Report

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Pawit Somnuke
Arunotai Siriussawakul
Sirirat Rattana-arpa

Abstract

Background: Irreversible electroporation (IRE) is not a familiar procedure to Thai anesthesiologists and is a relatively new alternative for treatment in patients with soft tissue tumors. This technique is considered a treatment arising from a new area of medicine that incorporates the principle of pulsed high-voltage engineering and cell biology. To date, there are still no definite anesthetic management guidelines for IRE. Objective: This study was designed to describe IRE anesthetic management and complications as well as postprocedural pain in Siriraj Hospital. Methods: In order to investigate IRE perioperative management and complications, the retrospective data of 14 patients who were scheduled for initial treatment in setting up IRE procedure in the Faculty of Medicine, Siriraj Hospital, were collected during 6 month-period (October 1, 2015 to March 31, 2016). Results: The patients’ mean age was 65.5 years old (range 53-75 years old). Eight patients were diagnosed with primary hepatic tumors, while the others had tumors from metastatic lesions. All the cases were operated under general anesthesia with endotracheal intubation. The intraprocedural complications, including hypo/ hypertension, bradycardia, and cardiac arrhythmia, are discussed in this report as well as the postoperative pain scores. No life-threatening complications were observed. Conclusion: IRE procedure required general anesthesia with endotracheal intubation and vigilant observation for hemodynamic instability, arrhythmia and pain. Moreover, close communication between the anesthesiologists and radio interventionists are a prerequisite for optimal patient care and for the minimization of adverse events.

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Case reports

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