Abstract
We report on five patients who underwent MRI-guided focused ultrasound ablation of prostatic cancer under epidural anesthesia with intravenous dexmedetomidine sedation. This pioneering procedure requires an immobile therapeutic field with adequate sedation and analgesia provided to the patients. Duration of the procedure is longer compared to diagnostic MRI scans. In combination with epidural anesthesia, dexmedetomidine was used to provide moderate levels of sedation without causing respiratory depression or hemodynamic instability, and was useful in preventing shivering. The pharmacological properties of dexmedetomidine contribute to make this technique safe and effective.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
ExAblate® MR guided focused ultrasound system is being used for the first time for non-invasive treatment of prostate cancer–seven patients with prostate confined low risk cancer treated in clinical trials. http://www.insightec.com/Prostate-Trials.html, 2010.
Siddiqui K, Chopra R, Vedula S, Sugar L, Haider M, Boyes A, Musquera M, Bronskill M, Klotz L. MRI-guided transurethral ultrasound therapy of the prostate gland using real-time thermal mapping: initial studies. Urology. 2010;76:1506–11.
Wilt TJ, MacDonald R, Rutks I, Shamliyan TA, Taylor BC, Kane RL. Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann Intern Med. 2008;148:435–48.
Hudson SB, Stewart EA. Magnetic resonance-guided focused ultrasound surgery. Clin Obstet Gynecol. 2008;51:159–66.
Tempany CM, Stewart EA, McDannold N, Quade B, Jolesz F, Hynynen K. MR imaging-guided focused ultrasound surgery of uterine leiomyomas: a feasibility study. Radiology. 2003;226:897–905.
Missant C, Van de Velde M. Morbidity and mortality related to anaesthesia outside the operating room. Curr Opin Anaesthesiol. 2004;17:323–7.
Metzner J, Posner KL, Domino KB. The risk and safety of anaesthesia at remote locations: the US closed claims analysis. Curr Opin Anaesthesiol. 2009;22:502–8.
Hsu YW, Cortinez LI, Robertson KM, Keifer JC, Sum-Ping ST, Moretti EW, Young C, Wright D, Macleod D, Somma J. Part I: Dexmedetomidine pharmacodynamics. Anesthesiology. 2004;101:1066–76.
Mason KP, Zurakowski D, Zgleszewski SE, Robson C, Carrier M, Hickey P, Dinardo J. High dose dexmedetomidine as the sole sedative for pediatric MRI. Paediatr Anaesth. 2008;18:403–11.
Mahmoud M, Gunter J, Donnelly LF, Wang Y, Nick TG, Sadhisvam S. A comparison of dexmedetomidine with propofol for magnetic resonance imaging sleep studies in children. Anesth Analg. 2009;109:745–53.
Akin S, Ariboqan A, Arsian G. Dexmedetomidine as an adjunct to epidural analgesia after abdominal surgery in elderly intensive care patients: a prospective, double-blind, clinical trial. Curr Ther Res. 2008;69:16–28.
Blaine Easley R, Brady KM, Tobias JD. Dexmedetomidine for the treatment of postanesthesia shivering in children. Paediatr Anaesth. 2007;17:341–6.
Elvan EG, Oc B, Uzun S, Karabulut E, Coskun E, Aypar U. Dexmedetomidine and postoperative shivering in patients undergoing elective abdominal hysterectomy. Eur J Anaesthesiol. 2008;25:357–64.
Hall JE, Uhrich TD, Barney J, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg. 2000;90:699–705.
Acknowledgments
We are grateful to Professor C. Cheng and colleagues for their team-based approach in this procedure.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Ng, A.T.L., Ip-Yam, P.C. Epidural anesthesia with intravenous dexmedetomidine sedation in the successful anesthetic management of MRI-guided focused ultrasound ablation of early prostatic cancer. J Anesth 25, 756–759 (2011). https://doi.org/10.1007/s00540-011-1189-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-011-1189-1