Comparative Effects of Dexmedetomidine and Propofol on US-Guided Radiofrequency Ablation of Hepatic Neoplasm Under Monitored Anesthesia Care

Abstract

Percutaneous radiofrequency ablation (RFA) is a useful and safe procedure for treating hepatic neoplasm. However, liver RFA causes severe pain, which thereby increases the demand for monitored anesthesia care (MAC). Here, we compared the efficacy and safety of propofol and dexmedetomidine, which are commonly administered during MAC when performing RFA to assess hepatic neoplasm.In this randomized controlled trial, 40 patients were randomly allocated to 2 groups for elective RFA. Patients received either dexmedetomidine (group D) or propofol (group P). Both groups received the continuous infusion of remifentanil for pain control. The primary outcomes were opioid consumption and differences in partial pressure of arterial carbon dioxide (PaCO2) between pre- and postprocedure RFA. In addition, hemodynamic parameters, patient satisfaction, and interventional radiologist satisfaction were determined.There were significant differences in opioid consumption (50.1 ± 16.8 ng/kg/min [group D] vs 71.2 ± 18.7 ng/kg/min [group P]; P = 0.001) and delta PaCO2 (10.4 ± 6.4 mm Hg vs 17.2 ± 9.2 mm Hg, respectively; P = 0.016). Moreover, respiratory rates were significantly different between groups during RFA (P < 0.001). However, blood pressure and heart rate did not significantly change during RFA. Neither patient nor interventional radiologist satisfaction was significantly different between groups.Dexmedetomidine provides better respiratory stability and reduces opioid consumption in comparison with propofol when administered under MAC when performing RFA for hepatic neoplasm.

Transthoracic radiofrequency ablation for hepatic tumor located beneath the diaphragm under one-lung ventilation

“…These patients can be managed with sedatives and opioids effectively. [3] In our patient, BP, HR, and SPI increased after initiation of RFA. Although patients treated with transthoracic approach do not feel any discomfort because of general anesthesia, analgesic drug concentration should be modulated through vital signs and SPI values during procedure.…”

“…The percutaneous approach is the most common approach for RFA application and can be done under monitored anesthesia care. [3] The laparoscopic approach and laparotomy can also be used under general anesthesia. [4,5] However, hepatic tumors that located immediately beneath the diaphragm are difficult to treat with percutaneous RFA due to poor visualization by percutaneous ultrasonography (US) and the close location of the heart or lung.…”

Thera-Band application changes muscle activity and kyphosis and scapular winging during knee push-up plus in subjects with scapular winging

“…One-way repeated analysis of variance (within factors: no Thera-Band, occiput, and thoracic region) was used to assess the statistical significance of RA activity, TKA, SA activity, and SW by using PASW Statistics 23 (SPSS, Chicago, IL). [ 35 ] The significance level was set at α = 0.05. If a significant difference was found, Bonferroni adjustment was performed (with α = 0.05/3 = 0.017).…”

Tactile cues change trunk and scapular muscle activity, scapular winging, and thoracic kyphosis during knee push-up plus in subjects with scapular winging

“…One-way repeated analysis of variance of the within-subject factors (no cue, tactile cue to TSP, and tactile cue to ISR) was used to assess the statistical significance of TES, RA, LT, SA, and UT EMG activities; scapular winging; and thoracic kyphosis using PASW Statistics 18 (SPSS, Chicago, IL). [ 25 ] The level of significance was set at α = 0.05. We used Bonferroni correction for the pairwise comparisons when significant differences were detected (α = 0.05/3).…”