Anesthesia for Percutaneous Radiofrequency Tumor Ablation (PRFA): A Review of Current Practice and Techniques

Federico Piccioni,¹ Andrea Poli,¹ Leah Carol Templeton,² T Wesley Templeton,² Marco Rispoli,³ Luigi Vetrugno,⁴ Domenico Santonastaso,⁵ Franco Valenza<sup>1,6

1</sup>Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; ²Department of Anesthesiology, Wake Forest University, Winston-Salem, NC, USA; ³Anesthesia and Intensive Care Unit, V. Monaldi Hospital, Naples, Italy; ⁴Anesthesia and Intensive Care Unit, Santa Maria della Misericordia University Hospital, Udine, Italy; ⁵Anesthesia and Intensive Care Unit, M. Bufalini Hospital, Cesena, Italy; ⁶Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy

Correspondence: Federico Piccioni
Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan 20133, Italy
Tel +39 2 23902282
Fax +39 2 23903366
Email federico.piccioni@istitutotumori.mi.it

Abstract: Percutaneous radiofrequency ablation (PRFA) of solid tumors is a minimally invasive procedure used to treat primary or metastatic cancer lesions via needle targeted thermal energy transfer. Some of the most common tumor lesions treated using PRFA include those within the liver, lungs and kidneys. Additionally, bone, thyroid, and breast lesions can also be treated. In most cases, this procedure is performed outside of the operating room in a specialized radiology suite. As a result, the clinician must adapt in many cases to the specific environmental issues attendant to providing anesthesia outside the operating room, including the lack of availability of an anesthesia machine in some cases, and frequently a lack of adequate scavenging and other specialized monitoring and equipment. At this time, routine practice and anesthetic prescriptions for PRFA can vary widely, ranging from patients receiving local anesthesia alone, to monitored anesthesia care, to regional anesthesia, to combined regional and general anesthesia. The choice of anesthetic technique will depend on tumor location and practitioner experience. This review aims to summarize the current state of the art in terms of anesthetic techniques for patients undergoing PRFA of solid tumors.

Keywords: anesthesia, conduction, deep sedation, conscious sedation, neoplasms, radiofrequency ablation, radiography, interventional