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BJA Advance Access published online on April 3, 2009
British Journal of Anaesthesia, doi:10.1093/bja/aep051
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

High-frequency jet ventilation for minimizing breathing-related liver motion during percutaneous radiofrequency ablation of multiple hepatic tumours

P. Biro1,*,{dagger}, D. R. Spahn1,{dagger} and T. Pfammatter2

1 Institute of Anaesthesiology
2 Institute of Radiology, University Hospital Zurich, CH-8091 Zurich, Switzerland

* Corresponding author. E-mail: peter.biro{at}usz.ch

Movements of the liver caused by spontaneous breathing (during sedation or local anaesthesia) or by ventilation during anaesthesia are a source of concern in CT-guided procedures because of the limited spatial and contrast resolution of unenhanced imaging, artifacts caused by the probes and the relatively low temporal resolution of the fluoroscopy mode. During CT-guided radiofrequency ablation (RFA), it is essential that the lesion can be visualized optimally and that the ablation probe is positioned accurately to avoid non-target injuries. We therefore used high-frequency jet ventilation and general anaesthesia to minimize ventilation-related liver movement and provide optimal conditions for a patient undergoing RFA of hepatic metastases. The technical and anaesthetic considerations are discussed, and a specific limitation of transcutaneous PCO2 measurement during activation of the ablation is reported for the first time.

Keywords: ablation techniques; liver, neoplasms; surgery, hepatic; ventilation, high-frequency jet

{dagger} Declaration of interest. P.B. has been involved in the development and design of the jet ventilation catheter used in this case and mentioned in this article. In the past 5 years, D.R.S. has received honoraria or travel support for consulting or lecturing from the following companies: Abbott AG, Baar, Switzerland; Alliance Pharmaceutical Corp., San Diego, CA, USA; AstraZeneca AG, Zug, Switzerland; Bayer (Schweiz) AG, Zürich, Switzerland; B. Braun Melsungen AG, Melsungen, Germany; CSL Behring GmbH, Hattersheim am Main, Germany; Fresenius SE, Bad Homburg v.d.H., Germany; Galenica AG, Bern, Switzerland (including Vifor SA, Villars-sur-Glâne, Switzerland); GlaxoSmithKline GmbH & Co. KG, Hamburg, Germany; Janssen-Cilag AG, Baar, Switzerland; Novo Nordisk A/S, Bagsvärd, Denmark; Octapharma AG, Lachen, Switzerland; Organon AG, Pfäffikon/SZ, Switzerland; and Roche Pharma (Schweiz) AG, Reinach, Switzerland.


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