Patient Preparationanesthesia

The use of a mild bowel prep prior to the ablation procedure results in improved tumor visualization under US due to less bowel gas, and a decrease in the incidence of postprocedure ileus. Nothing per oral after midnight before the procedure allows either conscious sedation or general anesthesia to be administered safely. The use of antibiotics prior to ablation is controversial. Some institutions routinely use prophylactic antibiotics to provide coverage for skin organisms; however, there is currently no compelling data to indicate that this is necessary. Despite this, at the present time, at our institution, we administer 1 mg Kefzol IV just prior to the procedure.

There is also no consensus as to the most appropriate procedural anesthesia. In general, renal ablation is less painful than liver ablation due to the retroperitoneal location of the kidneys, but there still may be substantial pain resulting from the procedure. General anesthesia, conscious sedation, or a combination of the two has been utilized with success at different institutions. General anesthesia has significant procedural advantages over conscious sedation, including decreased patient movement during the ablation, decreased patient discomfort, and improved patient monitoring. However, general anesthesia is resource and personnel intensive, and can have risks and complications that are magnified in a medically unfit population. Thus, there is no preferred type of procedural anesthesia and practitioners have had success with both methods. One special circumstance that must be considered is when the tumor is adjacent to the adrenal gland. Heating of the adrenal gland during RF ablation can result in a hypertensive crisis (25). Therefore, in cases where the target tumor is close to the adrenal, it is important to have anesthesia support on hand to manage any lability in blood pressure. Placing an arterial line prior to the procedure for blood pressure monitoring is also very helpful in the management of these patients.

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