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Jet Ventilation Reduces Coronary Sinus Movement in Patients Undergoing Atrial Fibrillation Ablation: An Observational Crossover Study. J Pers Med 2023; 13:jpm13020186. [PMID: 36836420 PMCID: PMC9967483 DOI: 10.3390/jpm13020186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/18/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND One of the reasons that high-frequency jet ventilation (HFJV) is used is due to the near immobility of thoracic structures. However, no study has quantified the movements of cardiac structures during HFJV compared with normal mechanical ventilation. METHODS After ethical approval and written informed consent, we included 21 patients scheduled for atrial fibrillation ablation in this prospective crossover study. Each patient was ventilated with both normal mechanical ventilation and HFJV. During each ventilation mode, displacements of the cardiac structure were measured by the EnSite Precision mapping system using a catheter placed in the coronary sinus. RESULTS The median [Q1-Q4] displacement was 2.0 [0.6-2.8] mm during HFJV and 10.5 [9.3-13.0] mm during conventional ventilation (p < 0.000001). CONCLUSION This study quantifies the minimal movement of cardiac structures during HFJV compared to standard mechanical ventilation.
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Galmén K, Jakobsson JG, Perchiazzi G, Freedman J, Harbut P. Quantitative assessment of atelectasis formation under high frequency jet ventilation during liver tumour ablation-A computer tomography study. PLoS One 2023; 18:e0282724. [PMID: 37011083 PMCID: PMC10069764 DOI: 10.1371/journal.pone.0282724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/21/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND High frequency jet ventilation (HFJV) can be used to minimise sub-diaphragmal organ displacements. Treated patients are in a supine position, under general anaesthesia and fully muscle relaxed. These are factors that are known to contribute to the formation of atelectasis. The HFJV-catheter is inserted freely inside the endotracheal tube and the system is therefore open to atmospheric pressure. AIM The aim of this study was to assess the formation of atelectasis over time during HFJV in patients undergoing liver tumour ablation under general anaesthesia. METHOD In this observational study twenty-five patients were studied. Repeated computed tomography (CT) scans were taken at the start of HFJV and every 15 minutes thereafter up until 45 minutes. From the CT images, four lung compartments were defined: hyperinflated, normoinflated, poorly inflated and atelectatic areas. The extension of each lung compartment was expressed as a percentage of the total lung area. RESULT Atelectasis at 30 minutes, 7.9% (SD 3.5, p = 0.002) and at 45 minutes 8,1% (SD 5.2, p = 0.024), was significantly higher compared to baseline 5.6% (SD 2.5). The amount of normoinflated lung volumes were unchanged over the period studied. Only a few minor perioperative respiratory adverse events were noted. CONCLUSION Atelectasis during HFJV in stereotactic liver tumour ablation increased over the first 45 minutes but tended to stabilise with no impact on normoinflated lung volume. Using HFJV during stereotactic liver ablation is safe regarding formation of atelectasis.
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Affiliation(s)
- Karolina Galmén
- Department of Anaesthesiology, Danderyd University Hospital, Stockholm, Sweden
| | - Jan G Jakobsson
- Department of Anaesthesiology, Danderyd University Hospital, Stockholm, Sweden
| | - Gaetano Perchiazzi
- Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University, Uppsala, Sweden
- Department of Anaesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Jacob Freedman
- Department of Surgery and Urology, Danderyd University Hospital, Stockholm, Sweden
- Division of Clinical Sciences, Karolinska Institutet at Danderyd University Hospital, Stockholm, Sweden
| | - Piotr Harbut
- Department of Anaesthesiology, Danderyd University Hospital, Stockholm, Sweden
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Gabriels JK, Ying X, Purkayastha S, Braunstein E, Liu CF, Markowitz SM, Mountantonakis S, Thomas G, Goldner B, Willner J, Goyal R, Ip JE, Lerman BB, Carter J, Bereanda N, Fitzgerald MM, Anca D, Patel A, Cheung JW. Safety and Efficacy of a Novel Approach to Pulmonary Vein Isolation Using Prolonged Apneic Oxygenation. JACC Clin Electrophysiol 2022; 9:497-507. [PMID: 36752460 DOI: 10.1016/j.jacep.2022.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Improved ablation catheter-tissue contact results in more effective ablation lesions. Respiratory motion causes catheter instability, which impacts durable pulmonary vein isolation (PVI). OBJECTIVES This study sought to evaluate the safety and efficacy of a novel ablation strategy involving prolonged periods of apneic oxygenation during PVI. METHODS We conducted a multicenter, prospective controlled study of 128 patients (mean age 63 ± 11 years; 37% women) with paroxysmal atrial fibrillation undergoing PVI. Patients underwent PVI under general anesthesia using serial 4-minute runs of apneic oxygenation (apnea group; n = 64) or using standard ventilation settings (control group; n = 64). Procedural data, arterial blood gas samples, catheter position coordinates, and ablation lesion characteristics were collected. RESULTS Baseline characteristics between the 2 groups were similar. Catheter stability was significantly improved in the apnea group, as reflected by a decreased mean catheter displacement (1.55 ± 0.97 mm vs 2.25 ± 1.13 mm; P < 0.001) and contact force SD (4.9 ± 1.1 g vs 5.2 ± 1.5 g; P = 0.046). The percentage of lesions with a mean catheter displacement >2 mm was significantly lower in the apnea group (22% vs 44%; P < 0.001). Compared with the control group, the total ablation time to achieve PVI was reduced in the apnea group (18.8 ± 6.9 minutes vs 23.4 ± 7.8 minutes; P = 0.001). There were similar rates of first-pass PVI, acute PV reconnections and dormant PV reconnections between the two groups. CONCLUSIONS A novel strategy of performing complete PVI during apneic oxygenation results in improved catheter stability and decreased ablation times without adverse events. (Radiofrequency Ablation of Atrial Fibrillation Under Apnea; NCT04170894).
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Affiliation(s)
- James K Gabriels
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Xiaohan Ying
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Subhanik Purkayastha
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Eric Braunstein
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Christopher F Liu
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Steven M Markowitz
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Stavros Mountantonakis
- Division of Electrophysiology, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - George Thomas
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Bruce Goldner
- Division of Electrophysiology, Long Island Jewish Hospital, Northwell Health, Queens, New York, USA
| | - Jonathan Willner
- Division of Electrophysiology, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Rajat Goyal
- Division of Electrophysiology, Southside Hospital, Northwell Health, Bay Shore, New York, USA
| | - James E Ip
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Bruce B Lerman
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Jane Carter
- Department of Anesthesia, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Nicola Bereanda
- Department of Anesthesia, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Meghann M Fitzgerald
- Department of Anesthesia, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Diana Anca
- Department of Anesthesia, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Apoor Patel
- Division of Cardiac Electrophysiology, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA.
| | - Jim W Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA.
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4
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Mandel JE. Barriers to the acceptance of high frequency jet ventilation in the electrophysiology lab-a personal perspective. J Interv Card Electrophysiol 2022; 65:337-338. [PMID: 35488960 DOI: 10.1007/s10840-022-01230-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jeff E Mandel
- Department of Anesthesiology and Critical Care, Crozer-Chester Medical Center, 30 Medical Center Blvd., Upland, PA, 19013, USA.
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Babapoor-Farrokhran S, Alzubi J, Port Z, Khraisha O, Mainigi SK. Utility of High-frequency Jet Ventilation in Atrial Fibrillation Ablation. J Innov Card Rhythm Manag 2021; 12:4590-4593. [PMID: 34327044 PMCID: PMC8313182 DOI: 10.19102/icrm.2021.120708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/07/2021] [Indexed: 01/19/2023] Open
Abstract
Atrial fibrillation (AF) is the most common clinically significant arrhythmia that causes major morbidity and mortality. Catheter ablation focusing on pulmonary vein isolation is increasingly used for the treatment of symptomatic AF. Advances in ablation technologies and improved imaging and mapping have enhanced treatment efficiency but only modestly improved the efficacy. Another-but less commonly used-technology that can have a favorable impact involves enhancing the catheter-tissue contact by manipulating respiration to promote improved catheter stability and optimal contact. High-frequency jet ventilation (HFJV) is a mode of ventilation that can reduce respiratory movements to almost apneic conditions. In this review article, we aimed to highlight different studies, review the current literature regarding the utility of HFJV in AF ablation, and discuss the safety and efficacy of this approach relative to that of conventional ventilation.
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Affiliation(s)
| | - Jafar Alzubi
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, PA, USA
| | - Zachary Port
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, PA, USA
| | - Ola Khraisha
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, PA, USA
| | - Sumeet K. Mainigi
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, PA, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Vazquez R, Beermann SL, Fintelmann FJ, Mullen EM, Chitilian H. High-Frequency Jet Ventilation in the Prone Position to Facilitate Cryoablation of a Peridiaphragmatic Pulmonary Neoplasm: A Case Report. A A Pract 2020; 13:169-172. [PMID: 31045587 DOI: 10.1213/xaa.0000000000001024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Percutaneous cryoablation of pulmonary tumors at the posterior lung base is challenging due to diaphragmatic motion and the requirement for prone positioning. High-frequency jet ventilation allows oxygenation and ventilation with minimal diaphragmatic movement. In this case report, we describe the use of high-frequency jet ventilation in the prone position to facilitate the cryoablation of a peridiaphragmatic pulmonary neoplasm.
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Affiliation(s)
- Rafael Vazquez
- From the Departments of Anesthesia, Critical Care, and Pain Medicine
| | | | | | - Eleanor M Mullen
- From the Departments of Anesthesia, Critical Care, and Pain Medicine
| | - Hovig Chitilian
- From the Departments of Anesthesia, Critical Care, and Pain Medicine
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Boatta E, Cazzato RL, De Marini P, Canuet M, Garnon J, Heger B, Bernmann TM, Ramamurthy N, Jahn C, Lopez M, Gangi A. Embolisation of pulmonary arteriovenous malformations using high-frequency jet ventilation: benefits of minimising respiratory motion. Eur Radiol Exp 2019; 3:26. [PMID: 31286281 PMCID: PMC6614221 DOI: 10.1186/s41747-019-0103-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/28/2019] [Indexed: 01/20/2023] Open
Abstract
Background To evaluate patient radiation dose and procedural duration recorded during pulmonary arteriovenous malformation (PAVM) embolisation performed using high-frequency jet ventilation (HFJV) as compared with conventional intermittent positive pressure ventilation (IPPV) Methods Patients undergoing PAVM embolisation with HFJV assistance after April 2017 were retrospectively identified as group A, and those treated with IPPV before April 2017 as group B. Primary outcomes were patient radiation dose and procedural duration between groups A and B. Secondary outcomes were difference in diaphragmatic excursion between groups A and B, in group A with/without HFJ assistance, technical/clinical success, and complications. Results Twelve PAVMs were embolised in 5 patients from group A, and 15 PAVMs in 10 patients from group B. Mean patient radiation was significantly lower in group A than in group B (54,307 ± 33,823 mGy cm2 [mean ± standard deviation] versus 100,704 ± 43,930 mGy cm2; p = 0.022). Procedural duration was 33.4 ± 16.1 min in group A versus 57.4 ± 14.9 min in group B (p = 0.062). Diaphragmatic excursion was significantly lower in group A (1.3 ± 0.4 mm) than in group B (19.7 ± 5.2 mm; p < 0.001) and lower with near statistical significance in group A with HFJV than without HFJV (1.3 ± 0.4 mm versus 10.9 ± 3.1 mm; p = 0.062). Technical and clinical success was 100% in both groups, without relevant complications. Conclusion HFJV-assisted PAVM embolisation is a safe, feasible technique resulting in reduced patient radiation doses and procedural time.
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Abstract
PURPOSE OF REVIEW As the field of interventional pulmonology continues to expand and develop at a rapid pace, anesthesiologists are increasingly called upon to provide well tolerated anesthetic care during these procedures. These patients may not be candidates for surgical treatment and often have multiple comorbidities. It is important for anesthesiologists to familiarize themselves with these procedures and their associated risks and complications. RECENT FINDINGS The scope of the interventional pulmonologist's practice is varied and includes both diagnostic and therapeutic procedures. Bronchial thermoplasty is now offered as endoscopic treatment of severe asthma. Endobronchial lung volume reduction procedures are currently undergoing clinical trials and may become more commonplace. Interventional pulmonologists are performing medical thoracoscopy for the treatment and diagnosis of pleural disorders. Interventional radiologists are performing complex pulmonary procedures, often requiring anesthesia. SUMMARY The review summarizes the procedures now commonly performed by interventional pulmonologists and interventional radiologists. It discusses the anesthetic considerations for and common complications of these procedures to prepare anesthesiologists to safely care for these patients. Investigational techniques are also described.
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Buchan T, Walkden M, Jenkins K, Sultan P, Bandula S. High-Frequency Jet Ventilation During Cryoablation of Small Renal Tumours. Cardiovasc Intervent Radiol 2018; 41:1067-1073. [PMID: 29516243 PMCID: PMC5976690 DOI: 10.1007/s00270-018-1921-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 02/24/2018] [Indexed: 01/20/2023]
Abstract
AIM To evaluate the effect of high-frequency jet ventilation (HFJV) in place of standard intermittent positive-pressure ventilation (IPPV) on procedure duration, patient radiation dose, complication rates, and outcomes during CT-guided cryoablation of small renal tumours. MATERIALS AND METHODS One hundred consecutive CT-guided cryoablation procedures to treat small renal tumours under general anaesthesia were evaluated-50 with standard IPPV and 50 after the introduction of HFJV as standard practice. Anaesthesia and procedural times, ionising radiation dose, complications, and 1-month post-treatment outcomes were collected. RESULTS HFJV was feasible and safe in all cases. Mean procedure time and total anaesthetic time were shorter with HFJV (p = <0.0001). The number of required CT acquisitions (p = 0.0002) and total procedure patient radiation dose (p = 0.0027) were also lower in the HFJV group compared with the IPPV group. There were a total of four complications of Clavien-Dindo classification 3 or above-three in the IPPV group and one in the HFJV group. At 1-month follow-up, two cases (both in the IPPV group) demonstrated subtotal treatment. Both cases were subsequently successfully retreated with cryoablation. CONCLUSION By reducing target tumour motion during CT-guided renal cryoablation, HFJV can reduce procedure times and exposure to ionising radiation. HFJV provides an important adjunct to complex image-guided interventions, with potential to improve safety and treatment outcomes.
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Affiliation(s)
- Thea Buchan
- Imaging Department, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Miles Walkden
- Imaging Department, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Kathryn Jenkins
- Department of Anaesthesia, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Pervez Sultan
- Department of Anaesthesia, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Steve Bandula
- Centre for Medical Imaging, University College London, 250 Euston Road, London, NW1 2PG, UK.
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Galmén K, Harbut P, Freedman J, Jakobsson JG. High frequency jet ventilation for motion management during ablation procedures, a narrative review. Acta Anaesthesiol Scand 2017; 61:1066-1074. [PMID: 28804874 DOI: 10.1111/aas.12950] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 07/06/2017] [Accepted: 07/11/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND High frequency jet ventilation (HFJV) is a method of ventilation that has gained renewed interest over the recent years as it can reduce organ movement to near static conditions, thus enhancing surgical precision in minimal invasive procedures, for example, ablation procedures for atrial fibrillation and solid organ tumours. The aim of this review was to create a summary of the current evidence concerning the clinical use of HFJV for ablative procedures. METHOD PubMed was searched for the key words high frequency ventilation and ablation January 1990-December 2016. RESULT The search initially identified 34 papers, 14 met the inclusion criteria. Articles in other languages than English (n = 1), comments regarding other articles (n = 4) and articles that did not include HFJV or ablative procedures (n = 15) were excluded. Two articles were added from references in papers included from the primary search. Sixteen studies were finally included in the review; four updates/reviews and 12 papers with results from studies of HFJV on humans, with a total of 889 patients; 498 patients ventilated with HFJV and 391 controls. There were no randomised studies. The overall scientific quality of the studies was low. CONCLUSION There is a lack of well-designed studies evaluating HFJV during ablation procedures. The available information, while sparse, supports the effect of less tissue movement, resulting in better surgical precision and outcome; such as shorter procedural time, fewer shock waves (ESWL) and less recurrence of atrial fibrillation. Randomised controlled studies are needed in this promising area of research to prove its superiority to standard ventilation.
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Affiliation(s)
- K. Galmén
- Department of Anaesthesia & Intensive Care; Karolinska Institute; Danderyd University Hospital; Stockholm Sweden
| | - P. Harbut
- Department of Anaesthesia & Intensive Care; Karolinska Institute; Danderyd University Hospital; Stockholm Sweden
| | - J. Freedman
- Department of Surgery; Department of Clinical Sciences; Karolinska Institute; Danderyd University Hospital; Stockholm Sweden
| | - J. G. Jakobsson
- Department of Anaesthesia & Intensive Care; Karolinska Institute; Danderyd University Hospital; Stockholm Sweden
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Freedman J, Harbut P. Navigated Percutaneous Lung Ablation under High-Frequency Jet Ventilation of a Metastasis from a Wilms' Tumour: A Paediatric Case Report. Case Rep Oncol 2016; 9:400-404. [PMID: 27721758 PMCID: PMC5043196 DOI: 10.1159/000447772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 06/22/2016] [Indexed: 12/25/2022] Open
Abstract
This is a case report of microwave energy being used to ablate an inoperable metastasis of a Wilms’ tumour in a 6-year-old boy using state-of-the-art navigated computed tomography targeting and high-frequency jet ventilation to reduce organ displacement and the potential risk of procedure-related pneumothorax. After the ablation, the young boy had high-dose chemotherapy followed by an autologous stem cell transplantation with rapid reduction of three recurrent right-sided lung metastases.
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Affiliation(s)
- Jacob Freedman
- Department of Surgery and Urology, Danderyd University Hospital, Stockholm, Sweden
| | - Piotr Harbut
- Department of Anaesthesiology, Danderyd University Hospital, Stockholm, Sweden
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Chung DYF, Tse DML, Boardman P, Gleeson FV, Little MW, Scott SH, Anderson EM. High-frequency jet ventilation under general anesthesia facilitates CT-guided lung tumor thermal ablation compared with normal respiration under conscious analgesic sedation. J Vasc Interv Radiol 2014; 25:1463-9. [PMID: 24819833 DOI: 10.1016/j.jvir.2014.02.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 02/10/2014] [Accepted: 02/21/2014] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To determine whether technical difficulty of computed tomography (CT)-guided percutaneous lung tumor thermal ablations is altered with the use of high-frequency jet ventilation (HFJV) under general anesthesia (GA) compared with procedures performed with normal respiration (NR) under conscious sedation (CS). MATERIALS AND METHODS Thermal ablation treatment sessions performed with NR under CS or HFJV under GA with available anesthesia records and CT fluoroscopic images were retrospectively reviewed; 13 and 33 treatment sessions, respectively, were identified. One anesthesiologist determined the choice of anesthesiologic technique independently. Surrogate measures of procedure technical difficulty--time duration, number of CT fluoroscopic acquisitions, and radiation dose required for applicator placement for each tumor--were compared between anesthesiologic techniques. The anesthesiologist time and complications were also compared. Parametric and nonparametric data were compared by Student independent-samples t test and χ(2) test, respectively. RESULTS Patients treated with HFJV under GA had higher American Society of Anesthesiologists classifications (mean, 2.66 vs 2.23; P = .009) and smaller lung tumors (16.09 mm vs 27.38 mm; P = .001). The time duration (220.30 s vs 393.94 s; P = .008), number of CT fluoroscopic acquisitions (10.31 vs 19.13; P = .023), and radiation dose (60.22 mGy·cm vs 127.68 mGy·cm; P = .012) required for applicator placement were significantly lower in treatment sessions performed with HFJV under GA. There was no significant differences in anesthesiologist time (P = .20), rate of pneumothorax (P = .62), or number of pneumothoraces requiring active treatment (P = .19). CONCLUSIONS HFJV under GA appears to reduce technical difficulty of CT-guided percutaneous applicator placement for lung tumor thermal ablations, with similar complication rates compared with treatment sessions performed with NR under CS. The technique is safe and may facilitate treatment of technically challenging tumors.
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Affiliation(s)
- Daniel Yiu Fai Chung
- Department of Radiology, Churchill Hospital, Oxford University Hospitals, Surgery and Diagnostic Building, Old Road, Headington, Oxford OX3 7LE, United Kingdom
| | - Donald Man Lap Tse
- Department of Radiology, Churchill Hospital, Oxford University Hospitals, Surgery and Diagnostic Building, Old Road, Headington, Oxford OX3 7LE, United Kingdom
| | - Philip Boardman
- Department of Radiology, Churchill Hospital, Oxford University Hospitals, Surgery and Diagnostic Building, Old Road, Headington, Oxford OX3 7LE, United Kingdom
| | - Fergus Vincent Gleeson
- Department of Radiology, Churchill Hospital, Oxford University Hospitals, Surgery and Diagnostic Building, Old Road, Headington, Oxford OX3 7LE, United Kingdom
| | - Mark William Little
- Department of Radiology, Churchill Hospital, Oxford University Hospitals, Surgery and Diagnostic Building, Old Road, Headington, Oxford OX3 7LE, United Kingdom
| | - Shaun Haig Scott
- Nuffield Department of Anaesthesia, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
| | - Ewan Mark Anderson
- Department of Radiology, Churchill Hospital, Oxford University Hospitals, Surgery and Diagnostic Building, Old Road, Headington, Oxford OX3 7LE, United Kingdom.
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CERESNAK SCOTTR, KAHANA MADELYN, ZUCKER HOWARDA, MANN GLENN, NAPPO LYNN, PASS ROBERTH. Effects of Ventilation and Catheter Position on Catheter Movement on the Tricuspid Annulus during Ablation in Children. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1051-7. [DOI: 10.1111/pace.12393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 02/06/2014] [Accepted: 02/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- SCOTT R. CERESNAK
- Pediatric Electrophysiology; Division of Pediatric Cardiology; Department of Pediatrics; Stanford University-Lucille Packard Children's Hospital; Palo Alto California
| | - MADELYN KAHANA
- Division of Pediatric Anesthesiology; Department of Anesthesiology; The Children's Hospital at Montefiore; Albert Einstein College of Medicine; Bronx New York
| | - HOWARD A. ZUCKER
- Division of Pediatric Anesthesiology; Department of Anesthesiology; The Children's Hospital at Montefiore; Albert Einstein College of Medicine; Bronx New York
| | - GLENN MANN
- Division of Pediatric Anesthesiology; Department of Anesthesiology; The Children's Hospital at Montefiore; Albert Einstein College of Medicine; Bronx New York
| | - LYNN NAPPO
- Pediatric Arrhythmia Service, Division of Pediatric Cardiology; Department of Pediatrics; The Children's Hospital at Montefiore, Albert Einstein College of Medicine; Bronx New York
| | - ROBERT H. PASS
- Pediatric Arrhythmia Service, Division of Pediatric Cardiology; Department of Pediatrics; The Children's Hospital at Montefiore, Albert Einstein College of Medicine; Bronx New York
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15
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Use of High-Frequency Jet Ventilation for Percutaneous Tumor Ablation. Cardiovasc Intervent Radiol 2013; 37:140-6. [DOI: 10.1007/s00270-013-0620-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 12/07/2012] [Indexed: 10/26/2022]
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