1
|
Sax L, Sharma S, Benedict J, Guy K, Mandybur I, Bittner M, Sinacori J, Rubinstein B. Comparison of Hemodynamics in Jet Ventilation vs. Intermittent Apnea for Airway Stenosis Surgery. Laryngoscope 2024; 134:1343-1348. [PMID: 37724978 DOI: 10.1002/lary.31045] [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: 03/05/2023] [Revised: 07/23/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE The objective of this study is to assess the impact of two different ventilation techniques, jet ventilation and apneic anesthesia with intermittent ventilation (AAIV), on patient hemodynamics and operative time during endoscopic laryngotracheal stenosis surgery. METHODS Retrospective chart review of patients who underwent airway dilation for laryngotracheal stenosis by a single surgeon at a single institution from October 1, 2000 through January 2, 2020. Logistic regression, Mann-Whitney U tests and chi square analysis were used to determine statistical significance. RESULTS A total of 157 patients, 43 (27.4%) male and 114 (72.6%) female, and 605 total encounters were included for analysis. There were no significant differences in hemodynamic outcomes when comparing the AAIV and jet ventilation groups. Specifically, there was no significant difference in either peak end-tidal CO2 or nadir O2 saturation between the AAIV and jet ventilation groups (p = 0.4016) and (p = 0.1357), respectively. The patients in the AAIV group had a significantly higher median BMI 32.93 (27.40-39.40) compared with 28.80 (24.1-32.65) (p = 0.0001). Although not necessarily clinically significant, patients with higher BMI had lower median O2 nadirs (97.8%) than non-obese patients (99.2%) (p < 0.0001). The median total procedure time was equivalent when comparing the two ventilation techniques. CONCLUSION AAIV is a safe method of ventilation for patients undergoing endoscopic laryngotracheal stenosis surgery with no significant differences in patient hemodynamics or procedure time when compared with jet ventilation. AAIV was the preferred method of ventilation for obese patients undergoing endoscopic laryngotracheal stenosis surgery. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1343-1348, 2024.
Collapse
Affiliation(s)
- Leah Sax
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Shaan Sharma
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Jacob Benedict
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Kevin Guy
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Ian Mandybur
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | | | - John Sinacori
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Benjamin Rubinstein
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| |
Collapse
|
2
|
Schindele A, Al-Sabtti S, Olofsson K. Human papilloma virus (HPV) vaccination is associated with reduced number of surgical treatments, an observational study on recurrent respiratory papillomatosis in Northern Sweden. Acta Otolaryngol 2024; 144:71-75. [PMID: 38484282 DOI: 10.1080/00016489.2024.2316264] [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: 11/21/2023] [Accepted: 02/05/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Recurrent respiratory papillomatosis (RRP) is a wart-like lesion mainly affecting the larynx, caused by human papillomavirus (HPV) genotypes 6 and 11. The disease affects both children and adults, and there is no cure. Surgery is the current symptom-relieving treatment; however, HPV vaccination is used as an adjuvant treatment. AIMS AND OBJECTIVES The aims were to study effects of HPV vaccination in RRP cases and to compare juvenile-onset to adult-onset disease and high treatment frequency (TF) to low TF cases. MATERIAL AND METHODS Medical records of RRP patients were studied from May 2006 to January 2023. Eighty-five RRP cases, tested for HPV genotypes with PapilloCheck®, were included. Vaccination- onset- and treatment analysis were performed. RESULTS Twelve percent of the cases were vaccinated. The number of surgeries decreased from 2.0 to 0.8/year after HPV vaccination. Most cases had an adult-onset and less than one treatment per year. Juvenile-onset cases had a higher vaccination treatment ratio compared to adult-onset. CONCLUSIONS HPV vaccination was associated with a lower number of treatments per year, supporting the use of vaccination as an adjuvant treatment. SIGNIFICANCE Vaccination as adjuvant treatment to surgery may lead to increased quality of life for RRP patients and saved healthcare resources.
Collapse
Affiliation(s)
- Alexandra Schindele
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Östersund, Sweden
| | - Semma Al-Sabtti
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden
| | - Katarina Olofsson
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden
| |
Collapse
|
3
|
Chan KC, Yang TX, Khu KF, So CV. High-flow Nasal Cannula versus Conventional Ventilation in Laryngeal Surgery: A Systematic Review and Meta-analysis. Cureus 2023; 15:e38611. [PMID: 37284366 PMCID: PMC10239706 DOI: 10.7759/cureus.38611] [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] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
High-flow nasal cannula (HFNC) is an emerging option for maintaining oxygenation in patients undergoing laryngeal surgery, as an alternative to traditional tracheal ventilation and jet ventilation (JV). However, the data on its safety and efficacy is sparse. This study aims to aggregate the current data and compares the use of HFNC with tracheal intubation and jet ventilation in adult patients undergoing laryngeal surgery. We searched PubMed, MEDLINE (Medical Literature Analysis and Retrieval System Online, or MEDLARS Online), Embase (Excerpta Medica Database), Google Scholar, Cochrane Library, and Web of Science. Both observational studies and prospective comparative studies were included. Risk of bias was appraised with the Cochrane Collaboration Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I) or RoB2 tools and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for case series. Data were extracted and tabulated as a systematic review. Summary statistics were performed. Meta-analyses and trial sequential analyses of the comparative studies were performed. Forty-three studies (14 HFNC, 22 JV, and seven comparative studies) with 8064 patients were included. In the meta-analysis of comparative studies, the duration of surgery was significantly reduced in the THRIVE (Transnasal Humidified Rapid-Insufflation Ventilatory Exchange) group, but the number of desaturations, need for rescue intervention, and peak end-tidal CO2 were significantly increased compared to the conventional ventilation group. The evidence was of moderate certainty and there was no evidence of publication bias. In conclusion, HFNC may be as effective as tracheal intubation in oxygenation during laryngeal surgery in selected adult patients and reduces the duration of surgery but conventional ventilation with tracheal intubation may be safer. The safety of JV was comparable to HFNC.
Collapse
Affiliation(s)
- Kai Chun Chan
- Department of Anaesthesiology and Operating Theatre Services, Queen Elizabeth Hospital, Kowloon, HKG
| | - Timothy Xianyi Yang
- Department of Anaesthesiology and Operating Theatre Services, Queen Elizabeth Hospital, Kowloon, HKG
| | - Kin Fai Khu
- Department of Anaesthesiology, Princess Margaret Hospital, Kowloon, HKG
| | - Ching Vincent So
- Department of Anaesthesiology, Queen Mary Hospital, Hong Kong Island, HKG
| |
Collapse
|
4
|
Meulemans J, Jans A, Vermeulen K, Vandommele J, Delaere P, Vander Poorten V. Evone® Flow-Controlled Ventilation During Upper Airway Surgery: A Clinical Feasibility Study and Safety Assessment. Front Surg 2020; 7:6. [PMID: 32185179 PMCID: PMC7058692 DOI: 10.3389/fsurg.2020.00006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/13/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction: During upper airway surgery in a narrowed airway due to tumor or stenosis, safe ventilation, good laryngotracheal exposure, and preservation of an adequate surgical working space are of paramount importance. This can be achieved by small-lumen ventilation such as High Frequency Jet Ventilation (HFJV). However, this technique has major drawbacks, such as air-trapping and desaturation in patients with poor pulmonary reserve. Recently, an innovative ventilating system with flow-controlled ventilation (FCV) and a small-lumen endotracheal tube, the Evone® (Ventinova, Eindhoven, The Netherlands), was introduced, claiming to counter the drawbacks of HFJV. Objectives: To evaluate feasibility and safety of the Evone® FCV system in difficult upper airway surgery and to critically appraise this novel ventilation method. Patients and methods: Evone® is a FCV-device using a small-bore cuffed tube (Tritube®). This ventilator actively sucks air out of the lungs, rather than relying on the passive backflow of air like in HFJV. Data related to the medical history, surgery, and anesthesia of all consecutive patients undergoing upper airway surgery with Evone® FCV ventilation were included in a tertiary center retrospective observational study. Results: Fifteen Patients, with a median age of 54 years, were included. Surgical procedures and indications included laser-assisted endoscopic treatment of idiopathic subglottic stenosis (n = 3), tracheal stenosis (n = 1), and posterior glottic stenosis (n = 2), biopsy and/or Transoral Laser Microsurgery for laryngeal (pre)malignancy (n = 7) and resection of benign lesions with posterior (supra)glottic location (n = 2). Mean ventilation duration was 52.0 min (range 30-115 min, SD 19.6 min), mean surgery duration was 31.7 min (range 15-65 min, SD 13.2 min), mean minimal SaO2 was 96.3% (range 89-100%, SD 4.0%) and mean peak pCO2 was 41.4 mmHg (range 31-50 mmHg, SD = 5.5 mmHg). No anesthesia- or surgery-related complications, adverse events or intra-operative difficulties were reported during or after any of the 15 procedures. In all cases, compared to HFJV, Evone® FCV ventilation allowed a superior visualization and working space during the surgical procedure. Conclusion: The Evone® FCV ventilation system provides excellent conditions in patients undergoing upper airway surgery, as it combines excellent accessibility and visibility of the operation site with safe and stable ventilation.
Collapse
Affiliation(s)
- Jeroen Meulemans
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Alexander Jans
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Pierre Delaere
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| |
Collapse
|
5
|
Airway Surgery Communication Protocol: A Quality Initiative for Safe Performance of Jet Ventilation. Laryngoscope 2019; 130 Suppl 1:S1-S13. [DOI: 10.1002/lary.28271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 12/26/2022]
|
6
|
Altun D, Çamcı E, Orhan-Sungur M, Sivrikoz N, Başaran B, Özkan-Seyhan T. High frequency jet ventilation during endolaryngeal surgery: Risk factors for complications. Auris Nasus Larynx 2018; 45:1047-1052. [PMID: 29373164 DOI: 10.1016/j.anl.2017.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/21/2017] [Accepted: 12/27/2017] [Indexed: 11/18/2022]
Abstract
Objective Microlaryngeal surgery requires teamwork between surgeons and anesthesiologists. High-frequency jet ventilation (HFJV) is an artificial breathing technique, preferred during endolaryngeal interventions, which offers a good solution for the requirements. Most studies investigating independent risk factors for intraoperative complications during HFJV in endolaryngeal surgery (ELS) has been retrospective and not standardized and the anesthetic approach has not been standardized. This prospective cohort study aimed to identify risk factors of complications related to HFJV in ELS under a standardized anesthesia regimen. Methods 243 patients who underwent ELS with infraglottic HFJV were investigated. Infraglottic jet ventilation catheter was placed and anesthesia was standardized. Demographic and operative data were noted. Hemodynamics, SpO2 and end-tidal CO2 were recorded at regular intervals. Complications such as hemodynamic disturbances, respiratory problems, barotrauma, equipment failure and requirement for conventional ventilation were also documented. Results 222 patients were included. Hypoxia, hypercapnia and the need for intubation were observed in 20(9%), 4(1.8%), 10(4.5%) patients. Bradycardia, hypotension and arrhythmia were observed in six (2.7%), 24(10.8%), and four (1.8%) patients respectively. Respiratory complications were associated with body mass index (BMI) (p < 0.001, OR: 1.57, 95%CI: 1.31–1.88) and previous major airway surgery (p < 0.001, OR: 34.0, 95%CI:3.52–328.24), whereas hemodynamic complications were associated with duration of the operation (p = 0.034, OR:1.04, 95%CI:1.0–1.09) and history of previous major airway surgery (p = 0.005, OR:9.57, 95%CI:1.97–46.49). Conclusion Infraglottic HFJV can be evaluated as an alternative breathing technique to conventional ventilation during endolaryngeal interventions. However, longer operation and previous laryngeal surgeries can increase the incidence of respiratory complications.
Collapse
Affiliation(s)
- Demet Altun
- Istanbul University, Istanbul Faculty of Medicine, Department of Anaesthesiology, Turkey.
| | - Emre Çamcı
- Istanbul University, Istanbul Faculty of Medicine, Department of Anaesthesiology, Turkey.
| | - Mukadder Orhan-Sungur
- Istanbul University, Istanbul Faculty of Medicine, Department of Anaesthesiology, Turkey.
| | - Nükhet Sivrikoz
- Istanbul University, Istanbul Faculty of Medicine, Department of Anaesthesiology, Turkey.
| | - Bora Başaran
- Department of Sore Throat Neck Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Tülay Özkan-Seyhan
- Istanbul University, Istanbul Faculty of Medicine, Department of Anaesthesiology, Turkey.
| |
Collapse
|
7
|
Philips R, deSilva B, Matrka L. Jet ventilation in obese patients undergoing airway surgery for subglottic and tracheal stenosis. Laryngoscope 2017; 128:1887-1892. [PMID: 29288493 DOI: 10.1002/lary.27059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 11/02/2017] [Accepted: 11/18/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES/HYPOTHESIS To assess the feasibility of jet ventilation in obese patients and to compare complications of jet ventilation in obese and nonobese patients. STUDY DESIGN Retrospective review of medical records. METHODS We reviewed 46 patient charts (70 procedures) with the diagnosis of tracheal or subglottic stenosis who underwent endoscopic surgery with jet ventilation between March 2014 and January 2017. Adequacy of jet ventilation was assessed by chest rise, avoidance of endotracheal intubation, and length of case and ventilation. Records were reviewed for demographic details, anesthesia records, and complications. RESULTS In 29/70 (41.4%) of cases, patients were obese; in 9/29 (31.0%) of these cases, patients were morbidly obese. Jet ventilation was successful in 28/29 (97%) of obese cases. In 1/29 (3.4%) of cases, the patient required alternative airway management. There were no significant differences between obese and nonobese patients in chest rise, need for endotracheal intubation, and length of surgery or ventilation (P > .05). There were 2/29 (6.9%) cases of intra- and postoperative complications including laryngospasm (1/29, 3.4%) and tachycardia (1/29, 3.4%). Rate of complications did not differ between obese and nonobese patients (P = .178). CONCLUSIONS Jet ventilation in obese patients can be done successfully, and complications are similar between obese patients and nonobese patients. LEVEL OF EVIDENCE 4. Laryngoscope, 1887-1892, 2018.
Collapse
Affiliation(s)
- Ramez Philips
- Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Brad deSilva
- Department of Otolaryngology-Head and Neck Surgery , The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Laura Matrka
- Department of Otolaryngology-Head and Neck Surgery , The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| |
Collapse
|
8
|
Mora F, Missale F, Incandela F, Filauro M, Parrinello G, Paderno A, Della Casa P, Piazza C, Peretti G. High Frequency Jet Ventilation during Transoral Laser Microsurgery for Tis-T2 Laryngeal Cancer. Front Oncol 2017; 7:282. [PMID: 29238695 PMCID: PMC5712543 DOI: 10.3389/fonc.2017.00282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 11/07/2017] [Indexed: 11/13/2022] Open
Abstract
Background Transoral laser microsurgery (TLM) for early to intermediate laryngeal squamous cell cancer (SCC) can be technically challenging when adequate exposure of the posterior laryngeal compartment is required due to the presence of the orotracheal tube. The goal of our study was to analyze the efficacy of high frequency jet ventilation (HFJV) in achieving appropriate laryngeal exposure and safe oncologic resection of lesions located in such a position. Methods We reviewed the clinical records of 62 patients affected by Tis-T2 SCC of the posterior laryngeal compartment treated by TLM between 02/2012 and 12/2016. The cohort was divided into two groups according to the anesthesiologic technique used: Group A included patients treated using intraoperative infraglottic HFJV, while Group B encompassed patients treated by standard orotracheal intubation. The main outcome was postoperative surgical margin status. Group comparison analysis was performed. Results Significant difference in deep margin status was observed between the two groups: in Group A, the rate of negative deep margins was 86% compared to 56% in Group B (p = 0.04). A trend of better overall and superficial margin control was observed for patients treated using HFJV (Group A), although no statistical significance was achieved. Conclusion Use of HFJV during TLM allows easier and safer management of patients affected by Tis-T2 SCC of the posterior laryngeal compartment, reducing the rates of positive superficial and deep surgical margins.
Collapse
Affiliation(s)
- Francesco Mora
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Francesco Missale
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Fabiola Incandela
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Marta Filauro
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Giampiero Parrinello
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Palmiro Della Casa
- Department of Anaesthesiology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy
| |
Collapse
|
9
|
Barry RA, Fink DS, Pourciau DC, Hayley K, Lanius R, Hayley S, Sims E, McWhorter AJ. Effect of Increased Body Mass Index on Complication Rates during Laryngotracheal Surgery Utilizing Jet Ventilation. Otolaryngol Head Neck Surg 2017; 157:473-477. [PMID: 28675094 DOI: 10.1177/0194599817698679] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Jet ventilation has been used for >30 years as an anesthetic modality for laryngotracheal surgery. Concerns exist over increased risk with elevated body mass index (BMI). We reviewed our experience using jet ventilation for laryngotracheal stenosis to assess for complication rates with substratification by BMI. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods A total of 126 procedures with jet ventilation were identified from October 2006 to December 2014. Complications were recorded, including intubation, unplanned admission, readmission, dysphonia, oral trauma, pneumothorax, pneumomediastinum, and tracheostomy. Lowest intraoperative oxygen saturation and maximum end-tidal CO2 (ETCO2) levels were recorded. Results Among 126 patients, 43, 77, and 6 had BMIs of <25, 25-35, and 36-45, respectively. In the BMI <25 group, there was 1 unplanned intubation. Mean maximum ETCO2 was 36.51 with no hypoxemia observed. In the BMI 25-35 group, 2 patients required intubation, and 1 sustained minor oral trauma. The mean maximum ETCO2 was 38.85, with 4 patients having oxygen saturation <90%. In the BMI 36-45 group, 2 patients required intubation. The mean maximum ETCO2 was 41 with no hypoxemia observed. BMI and length of stenosis were statistically significant variables associated with incidence of intraoperative intubation. Conclusion Increased BMI was associated with an increase in highest ETCO2 intraoperatively. However, this was not associated with an increase in major complications. Jet ventilation was performed without significant adverse events in this sample, and it is a viable option if used with an experienced team in the management of laryngotracheal stenosis.
Collapse
Affiliation(s)
- Rachel A Barry
- 1 Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Daniel S Fink
- 2 Our Lady of the Lake Voice Center, Baton Rouge, Louisiana, USA
| | | | - Kasey Hayley
- 3 Our Lady of the Lake College, Baton Rouge, Louisiana, USA
| | - Rachael Lanius
- 3 Our Lady of the Lake College, Baton Rouge, Louisiana, USA
| | | | - Eddy Sims
- 3 Our Lady of the Lake College, Baton Rouge, Louisiana, USA
| | | |
Collapse
|
10
|
|
11
|
van Breugel JMM, Wijlemans JW, Vaessen HHB, de Greef M, Moonen CTW, van den Bosch MAAJ, Ries MG. Procedural sedation and analgesia for respiratory-gated MR-HIFU in the liver: a feasibility study. J Ther Ultrasound 2016; 4:19. [PMID: 27478615 PMCID: PMC4966712 DOI: 10.1186/s40349-016-0063-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 07/08/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Previous studies demonstrated both pre-clinically and clinically the feasibility of magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablations in the liver. To overcome the associated problem of respiratory motion of the ablation area, general anesthesia (GA) and mechanical ventilation was used in conjunction with either respiratory-gated energy delivery or energy delivery during induced apnea. However, clinical procedures requiring GA are generally associated with increased mortality, morbidity, and complication rate compared to procedural sedation and analgesia (PSA). Furthermore, PSA is associated with faster recovery and an increased eligibility for non- and mini-invasive interventions. METHODS In this study, we investigate both in an animal model and on a small patient group the kinetics of the diaphragm during free-breathing, when a tailored remifentanil/propofol-based PSA protocol inducing partial respiratory depression is used. Subsequently, we demonstrate in an animal study the compatibility of the resulting respiratory pattern of the PSA protocol with a gated HIFU ablation in the liver by direct comparison with gated ablations conducted under GA. Wilcoxon signed-rank tests were performed for statistical analysis of non-perfused and necrosed tissue volumes. Duty cycles (ratio or percentage of the breathing cycle with the diaphragm in its resting position, such that acoustic energy delivery with MR-HIFU was allowed) were statistically compared for both GA and PSA using student's t tests. RESULTS In both animal and human experiments, the breathing frequency was decreased below 9/min, while maintaining stable vital functions. Furthermore an end-exhalation resting phase was induced by this PSA protocol during which the diaphragm is virtually immobile. Median non-perfused volumes, non-viable volumes based on NADH staining, and duty cycles were larger under PSA than under GA or equal. CONCLUSIONS We conclude that MR-HIFU ablations of the liver under PSA are feasible and potentially increase the non-invasive nature of this type of intervention.
Collapse
Affiliation(s)
- Johanna M. M. van Breugel
- Division of Imaging, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Radiology, University Medical Center Utrecht, Postbox: 85500, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Joost W. Wijlemans
- Division of Imaging, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Martijn de Greef
- Division of Imaging, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chrit T. W. Moonen
- Division of Imaging, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Mario G. Ries
- Division of Imaging, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|