Monitored anesthesia care for percutaneous radiofrequency ablation of oncological lesions: a retrospective analysis and literature review

Abstract

Background & objective: Radiofrequency ablation (RFA) of solid tumors is a minimally invasive procedure intended to treat primary and/or metastatic, benign or malignant solid tumors; via thermal tissue destruction by means of targeted thermal energy guided coagulative necrosis. This procedure can be performed under sedation, general anesthesia (GA) or regional blocks. However, no defined modality exists. We analyzed the different anesthetic modalities and drug combinations which can provide optimal surgical conditions and a successful outcome. Secondary objectives were to analyze common adverse events associated with each anesthesia technique Methodology: In this retrospective study, a total of 100 patients were included based on completeness of records, valid consent from 2008-2018. Outcome measures were; demographic characteristics, ASA status, comorbidities, anesthetic management including drug combinations used, pain management modality, and complications - both intra-operative and post-operative complications. Data was assessed and analyzed using descriptive statistics. Results: Majority of the patients were male (55%), ASA physical class II/III (83%). Anesthesia drug combinations were classified as ketamine and non-ketamine based (85:15). Primary sites for RFA were liver (75%) followed by bone, kidney, adrenal and lungs. Main complications observed were pain and hypotension. Incidence of complications were higher in non-ketamine group. Conclusions: Most cases of radiofrequency ablation can be performed successfully under sedation with local anesthesia. Despite being minimally invasive, it requires complete preparation with general anesthesia back-up, and pre-operative assessment/investigations. Ketamine based combinations exhibited better patient compliance with lower complication rates than non-ketamine-based combinations. Abbreviations: GA - General anesthesia; MAC - Monitored anesthesia care; p-RFA - Percutaneous radiofrequency ablation; RFA - Radiofrequency ablation; TIVA - Total intravenous anesthesia; Keywords: Keta-dex, Ketamine, Radiofrequency ablation, RFA, Pain, Sedation, Monitored anesthesia care, MAC Citation: Pahade A, Mowar A, Vikas J, Singh V, Chowdhury C. Monitored anesthesia care for percutaneous radiofrequency ablation of oncological lesions: a retrospective analysis and literature review. Anaesth. pain intensive care 2024;28(3):534−540. DOI: 10.35975/apic.v28i3.2462 Received: January 24, 2024; Reviewed: March 29, 2024; Accepted: March 29, 2024