Propofol Compared to Midazolam Sedation and to General Anesthesia for Percutaneous Microwave Ablation in Patients with Hepatic Malignancies: A Single-Center Comparative Analysis of Three Historical Cohorts.

Autor: Puijk RS; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers - location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. r.puijk@amsterdamumc.nl., Ziedses des Plantes V; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers - location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands., Nieuwenhuizen S; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers - location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands., Ruarus AH; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers - location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands., Vroomen LGPH; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers - location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands., de Jong MC; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers - location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands., Geboers B; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers - location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands., Hoedemaker-Boon CJ; Department of Anesthesiology, Amsterdam University Medical Centers - location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands., Thöne-Passchier DH; Department of Anesthesiology, Amsterdam University Medical Centers - location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands., Gerçek CC; Department of Anesthesiology, Amsterdam University Medical Centers - location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands., de Vries JJJ; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers - location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands., van den Tol PMP; Department of Surgical Oncology, Amsterdam University Medical Centers - location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands., Scheffer HJ; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers - location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands., Meijerink MR; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers - location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Cardiovascular and interventional radiology [Cardiovasc Intervent Radiol] 2019 Nov; Vol. 42 (11), pp. 1597-1608. Date of Electronic Publication: 2019 Jun 26.
DOI: 10.1007/s00270-019-02273-y
Abstrakt: Purpose: In percutaneous ablation procedures, periprocedural pain, unrest and respiratory concerns can be detrimental to achieve a safe and efficacious ablation and impair treatment outcome. This study aimed to compare the association between anesthetic technique and local disease control in patients undergoing percutaneous microwave ablation (MWA) of colorectal liver metastases (CRLM) and hepatocellular carcinoma (HCC).
Materials and Methods: This IRB-exempted single-center comparative, retrospective analysis of three cohorts analyzed 90 patients treated for hepatic malignancies from January 2013 until September 2018. The local tumor progression-free survival (LTPFS), safety and periprocedural pain perception were assessed using univariate and multivariate Cox proportional hazard regression analyses to correct for potential confounders.
Results: In 114 procedures (22 general anesthesia; 32 midazolam; 60 propofol), 171 liver tumors (136 CRLM; 35 HCC) were treated with percutaneous MWA. Propofol and general anesthesia were superior to midazolam/fentanyl sedation regarding LTPFS (4/94 [4.3%] vs. 19/42 [45.2%] vs. 2/35 [5.7%]; P < 0.001, respectively). Local tumor progression rate was 14.6% (25/171). Eighteen tumors (72.0%) were retreated by ablation. Of them, 14 (78%) were previously treated with midazolam. Propofol versus midazolam (P < 0.001), general anesthesia versus midazolam (P = 0.016), direct postprocedural visual analog pain score above 5 (P = 0.050) and more than one tumor per procedure (P = 0.045) were predictors for LTPFS. Multivariate analysis revealed that propofol versus midazolam (HR 7.94 [95% CI 0.04-0.39; P < 0.001]) and general anesthesia versus midazolam (HR 6.33 [95% CI 0.04-0.69; P = 0.014]) were associated with LTPFS. Pain during and directly after treatment was significantly worse in patients who received midazolam sedation (P < 0.001).
Conclusions: Compared to propofol and general anesthesia, midazolam/fentanyl sedation was associated with an increased periprocedural perception of pain and lower local tumor progression-free survival. To reduce the number of repeat procedures required to eradicate hepatic malignancies, general anesthesia and propofol sedation should be favored over midazolam.
Databáze: MEDLINE
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