High-frequency jet ventilation for minimizing breathing-related liver motion during percutaneous radiofrequency ablation of multiple hepatic tumours.
Movements of the liver caused by spontaneous breathing (during sedation or local anaesthesia) or by ventilation during anaesthesia are a source of concern in CT-guided procedures because of the limited spatial and contrast resolution of unenhanced imaging, artifacts caused by the probes and the relatively low temporal resolution of the fluoroscopy mode. During CT-guided radiofrequency ablation (RFA), it is essential that the lesion can be visualized optimally and that the ablation probe is positioned accurately to avoid non-target injuries. We therefore used high-frequency jet ventilation and general anaesthesia to minimize ventilation-related liver movement and provide optimal conditions for a patient undergoing RFA of hepatic metastases. The technical and anaesthetic considerations are discussed, and a specific limitation of transcutaneous PCO(2) measurement during activation of the ablation is reported for the first time.
Biro
P
P
Institute of Anaesthesiology, University Hospital Zurich, CH-8091 Zurich, Switzerland. peter.biro@usz.ch
Spahn
D R
DR
Pfammatter
T
T
D017115:Catheter Ablation / Q000379:methods*; D006611:High-Frequency Jet Ventilation / Q000379:methods*; D006801:Humans; D008099:Liver; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009068:Movement; D015641:Radiography, Interventional / Q000379:methods; D012119:Respiration; D014057:Tomography, X-Ray Computed