title: Case study of hepatic radiofrequency ablation causing a systemic inflammatory response under total intravenous anesthesia.
abstract: OBJECTIVE
  To investigate the effects of hepatic radiofrequency ablation (RFA) in patients with malignant liver disease with respect to inflammation activation and stress response.
  
  
  METHODS
  In an observational trial, we investigated the physiologic parameters of 17 patients (20 interventions) who underwent percutaneous RFA under general anesthesia after applying total intravenous anesthesia. TNFα, IL-6, IL-8, IL-10, adrenaline and noradrenaline, liver enzymes, lactate and creatine kinase were determined pre-interventionally after induction of anesthesia (T1), 90 minutes after initiation of RFA (T2), immediately after the conclusion of the procedure (T3), and 24 hours after the procedure (T4).
  
  
  RESULTS
  A significant increase in body temperature (p < 0.001), and mean arterial pressure (p = 0.001) were measured intraoperatively (T2) and the day after the procedure (T4). Increased levels of IL-6 were measured at T3 and T4 (p = 0.001). IL-10 increased immediately after the procedure (T3; p = 0.007). IL-6 levels correlated well with the total energy applied (r = 0.837). Significant increases in the levels of adrenaline and noradrenaline were present at T3 and T4 (p < 0.001). The RFA-induced destruction of hepatic tissue was associated with increased levels of AST, ALT, GLDH and LDH.
  
  
  CONCLUSIONS
  Percutaneous RFA of hepatic malignancies causes an inflammatory and endocrine activation, similar to the systemic inflammatory response syndrome. These effects have to be taken in account when dealing with patients susceptible to sepsis or multi-organ failure.
authors.affiliation: Department of Anesthesiology, University Hospital, RWTH Aachen, Aachen, Germany.
authors.forename: Gereon
authors.initials: G
authors.lastname: Schälte
authors.forename: Dietrich
authors.initials: D
authors.lastname: Henzler
authors.forename: Christian
authors.initials: C
authors.lastname: Waning
authors.forename: Josef
authors.initials: J
authors.lastname: Tacke
authors.forename: Rolf
authors.initials: R
authors.lastname: Rossaint
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Mahnken
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000768:Anesthesia, General; D001831:Body Temperature; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D002851:Chromatography, High Pressure Liquid; D003131:Combined Modality Therapy; D004797:Enzyme-Linked Immunosorbent Assay; D004837:Epinephrine / Q000097:blood; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D015850:Interleukin-6; D016753:Interleukin-10; D009638:Norepinephrine; D004837:Epinephrine