title: Anesthetic techniques and complications in patients with hepatocellular carcinoma undergoing percutaneous ethanol injection.
abstract: OBJECTIVE
  The aim of this study was to analyze anesthetic techniques and complications found in patients with hepatocellular carcinoma (HCC) who have undergone percutaneous ethanol injection (PEI).
  
  
  METHODS
  A retrospective study was performed on 67 patients with HCC who underwent 120 sessions of ultrasound-guided PEI between January 2004 and April 2006.
  
  
  RESULTS
  The mean age of the patients was 56.4 (25-77) years. Males accounted for the majority of the patients (75%). The ASA classifications were from ASA class I (2.5%), class II (82.5%), and class III (15%). Premedication with benzodiazepines was given to 68.3% of the patients. In 81.7% of the procedures, the patients received total intravenous anesthesia with 13.3%, 4.2%, and 0.8% undergoing general anesthesia with either an endotracheal tube, general anesthesia with mask, or monitored anesthesia care, respectively. Most (95.8%) patients were given propofol. Thiopental and ketamine (1.7% each) were used as an induction agent. In only 0.8% of the sessions did the patient receive morphine as an intraprocedural analgesic, while 99.2% of the sessions received fentanyl. Isoflurane was delivered to all of the patients receiving general anesthesia. Bradycardia, hypotension, bradycardia plus hypotension and hypotension plus hypoxemia occurred in 0.8%, 6%, 0.8% and 0.8% of the sessions, respectively. A single patient (1.5% of the patients or 0.8% of the sessions) had cardiovascular collapse during the procedure. The mean duration of anesthesia was 34.7 (10-105) min and the patients were observed in a recovery room for a mean duration of 51.7 (0-175) min. The majority of the recovery room admissions (89.2%) did not have any complications. A minority of the cases (9.2%) received fentanyl in the recovery room as a means of pain management.
  
  
  CONCLUSIONS
  Various kinds of anesthesia are suitable for patients with HCC scheduled for ultrasound-guided PEI. Although PEI is not commonly associated with serious complications, it is not entirely risk-free and careful monitoring and prompt resuscitation are essential for the safety of the patients as the procedure is performed in an interventional radiology suite, which is considered to be a remote area.
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand snimmaanrat@yahoo.com.au
authors.forename: S
authors.initials: S
authors.lastname: Nimmaanrat
authors.forename: C
authors.initials: C
authors.lastname: Prechawai
authors.forename: W
authors.initials: W
authors.lastname: Tanomkiat
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D002492:Central Nervous System Depressants / Q000008:administration & dosage; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D002492:Central Nervous System Depressants; D000431:Ethanol