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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.
Irreversible electroporation (NanoKnife) in cancer treatment.
Gastrointest Interv 2014;3:8-18.
2. Bernard V, Andrašina T, Červinka D, et al. A Thermographic
comparison of irreversible electroporation and radiofrequency
ablation. IRBM 2017;38:26-33.
3. Ball C, Thomson KR, Kavnoudias H. Irreversible electroporation:
a new challenge in “out of operating theater” anesthesia.
Anesth Analg 2010;110:1305-9.
4. Schoenbach KH, Hargrave B, Joshi RP, et al. Bioelectric
effects of intense nanosecond pulses. IEEE Trans Dielectr
Electr Insul 2007;14:1088-109.
5. Schoenbach KH, Xiao S, Joshi RP, et al. The effect of intense
subnanosecond electrical pulses on biological cells. IEEE
Trans Plasma Sci 2008;36:414-22.
6. Altunc S. Subnanosecond pulsed-power generated
electricfields for cancer treatment. IEEE Nucl Plasma Sci Soc
7. Yu H, Burke CT. Comparison of percutaneous ablation
technologies in the treatment of malignant liver tumors.
Semin Intervent Radiol 2014;31:129-37.
8. Davalos R, Mir LM, Rubinsky B. Tissue ablation with
irreversible electroporation. Ann Biomed Eng 2005;33:
9. Rubinsky B, Onik G, Mikus P. Irreversible electroporation:
a new ablation modality-clinical implications. Technol Cancer
Res Treat 2007;6:37-48.
10. Lee EW, Loh CT, Kee ST. Imaging guided percutaneous
irreversible electroporation: ultrasound and immunohistological correlation. Technol Cancer Res Treat 2007;6:287-94.
11. Nault JC, Sutter O, Nahon P, Ganne-Carrié, Séror O.
Percutaneous treatment of hepatocellular carcinoma: State
of the art and innovations. J Hepatol 2018;68:783-97.
12. Tombesi P, Di Vece F, Sartori S. Radiofrequency, microwave,
and laser ablation of liver tumors: time to move toward
a tailored ablation technique?. Hepatoma Res 2015;1:52-7.
13. Baust JG, Gage AA, Bjerklund Johansen TE, Baust JM.
Mechanisms of cryoablation: Clinical consequences on
malignant tumors. Cryobiology 2014;68:1-11.
14. Nielsen K, Scheffer HJ, Vieveen JM, et al. Anaesthetic
management during open and percutaneous irreversible
electroporation. Br J Anaesth 2014;113:985-92.
15. Schneider C, Yale SH, Larson M. Principle of pain management.
Clin Med Res 2003;1:337-40.
16. Meng L, Yu W, Wang T, Zhang L, Heerdt PM, Gelb AW.
Blood pressure targets in perioperative care provisional
considerations based on a comprehensive literature review.
17. Månsson C, Nilsson A, Karlson BM. Severe complications
with irreversible electroporation of the pancreas in the
presence of a metallic stent: a warning of a procedure that
never should be performed. Acta Radiol Short Rep 2014;
18. Martin RC, Schwartz E, Adams J, Farah I, Derhake BM.
Intra-operative anesthesia management in patients undergoing surgical irreversible electroporation of the pancreas,
liver, kidney, and retroperitoneal tumors. Anesth Pain Med
19. Narayanan G, Froud T, Lo K, Barbery KJ, Perez-Rojas E,
Yrizarry J. Pain analysis in patients with hepatocellular
carcinoma: Irreversible electroporation versus radiofrequency
ablation-Initial observations. Cardiovasc Intervent Radiol
20. Andreano A, Galimberti S, Franza E, et al. Percutaneous
microwave ablation of hepatic tumors: prospective evaluation
of postablation syndrome and postprocedural pain. J Vasc
Interv Radiol 2014;25:97-105.