title: Intra - operative Anesthesia Management in Patients Undergoing Surgical Irreversible Electroporation of the Pancreas, Liver, Kidney, and Retroperitoneal Tumors.
abstract: BACKGROUND
  Irreversible electroporation (IRE) is a relatively new approach to the management of multiple types of locally advanced soft tissue tumors. Unique peri-procedural anesthetic management is needed in the safe and effective delivery of this therapy.
  
  
  OBJECTIVE
  This study analyzed IRE therapy in relation to anesthetic management for our initial cohort and then established and validated a set of best practical guidelines for general anesthesia in patients undergoing IRE for abdominal tumors.
  
  
  METHODS
  An IRB-approved prospective data collection outcome protocol was utilized. This study was broken up into two cohorts as follows: the initial 38 patients (pts) undergoing IRE in which anesthetic management was not defined or optimized and then a 40-pt validation cohort to establish the most efficacious anesthetic protocols.
  
  
  RESULTS
  During IRE delivery, a deeper neuromuscular blockade is required to ensure that all retroperitoneal muscle excitation was minimized. In the initial 38-pt cohort, attempts to treat hypertension (median SBP 190, range 185-215 and median diastolic 98, range 91-115) were made with various types of anti-hypertensives with minimal-to-insufficient effects. The established inhalation was sevoflurane with an approximate median dose of 8.0 volume percentage. Analgesic management of continuous remifentanil was utilized with epidural management, which optimized HTN and tolerance to IRE therapy.
  
  
  CONCLUSIONS
  Anesthetic management for IRE of soft tissue deviates from standard anesthetic medical therapy in regards to depth of neuromuscular blockade and analgesic management during IRE energy delivery. However, minor modifications in anesthesia management allow for a safe and efficient patient procedure.
authors.affiliation: Division of Surgical Oncology, University of Louisville School of Medicine, Louisville, USA ; James Graham Brown Cancer Center, Louisville, USA.
authors.forename: Robert Cg
authors.initials: RC
authors.lastname: Martin
authors.affiliation: Division of Surgical Oncology, University of Louisville School of Medicine, Louisville, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Schwartz
authors.affiliation: Department of Anesthesiology, University of Louisville School of Medicine, Louisville, USA.
authors.forename: JoAnn
authors.initials: J
authors.lastname: Adams
authors.affiliation: Department of Anesthesiology, University of Louisville School of Medicine, Louisville, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Farah
authors.affiliation: Department of Anesthesiology, University of Louisville School of Medicine, Louisville, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Derhake
keywords: Anesthetic; Electroporation; Tumors