High-frequency jet ventilation under general anesthesia facilitates CT-guided lung tumor thermal ablation compared with normal respiration under conscious analgesic sedation
Chung DYF., Tse DML., Boardman P., Gleeson FV., Little MW., Scott SH., Anderson EM.
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 χ2 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. © 2014 SIR.