title: High-frequency jet ventilation under general anesthesia facilitates CT-guided lung tumor thermal ablation compared with normal respiration under conscious analgesic sedation.
abstract: OBJECTIVE
  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).
  
  
  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 χ(2) 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.
authors.affiliation: Department of Radiology, Churchill Hospital, Oxford University Hospitals, Surgery and Diagnostic Building, Old Road, Headington, Oxford OX3 7LE, United Kingdom.
authors.forename: Daniel Yiu Fai
authors.initials: DY
authors.lastname: Chung
authors.affiliation: Department of Radiology, Churchill Hospital, Oxford University Hospitals, Surgery and Diagnostic Building, Old Road, Headington, Oxford OX3 7LE, United Kingdom.
authors.forename: Donald Man Lap
authors.initials: DM
authors.lastname: Tse
authors.affiliation: Department of Radiology, Churchill Hospital, Oxford University Hospitals, Surgery and Diagnostic Building, Old Road, Headington, Oxford OX3 7LE, United Kingdom.
authors.forename: Philip
authors.initials: P
authors.lastname: Boardman
authors.affiliation: Department of Radiology, Churchill Hospital, Oxford University Hospitals, Surgery and Diagnostic Building, Old Road, Headington, Oxford OX3 7LE, United Kingdom.
authors.forename: Fergus Vincent
authors.initials: FV
authors.lastname: Gleeson
authors.affiliation: Department of Radiology, Churchill Hospital, Oxford University Hospitals, Surgery and Diagnostic Building, Old Road, Headington, Oxford OX3 7LE, United Kingdom.
authors.forename: Mark William
authors.initials: MW
authors.lastname: Little
authors.affiliation: Nuffield Department of Anaesthesia, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom.
authors.forename: Shaun Haig
authors.initials: SH
authors.lastname: Scott
authors.affiliation: Department of Radiology, Churchill Hospital, Oxford University Hospitals, Surgery and Diagnostic Building, Old Road, Headington, Oxford OX3 7LE, United Kingdom. Electronic address: ewan.anderson@ouh.nhs.uk.
authors.forename: Ewan Mark
authors.initials: EM
authors.lastname: Anderson
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects; D016009:Chi-Square Distribution; D016292:Procedural Sedation / Q000009:adverse effects; D005260:Female; D006611:High-Frequency Jet Ventilation / Q000009:adverse effects; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011829:Radiation Dosage; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000009:adverse effects; D016896:Treatment Outcome