Skip to main content
SpringerLink
Log in

Risk factor for vital signs elevation during percutaneous microwave ablation of liver tumor under deep sedation

  • Original Article
  • Published:
Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the frequency and the degree of vital signs elevation, as well as to elucidate the risk factors for elevation of cardiopulmonary parameters.

Materials and methods

We retrospectively evaluated the medical records of 101 patients who received microwave ablation (MWA) under deep sedation with propofol. Univariate analysis followed by multivariate linear regression analysis was performed to determine the risk factors associated with the elevation of cardiopulmonary parameters.

Results

The heart rate (HR), mean blood pressure (BP) and respiratory rate (RR) were elevated in 53.5%, 45.5% and 30.7%. Hyperhemodynamic state (mean BP or HR increased > 30% of the baseline) and high RR (RR > 20 times/min) were detected in 23.8% and 13.9%. Age ≤ 50 years was signifiant for mean BP and HR elevation (p = 0.032; p = 0.027), ablation zone abutting the parietal peritoneum (p = 0.001; p = 0.001; p < 0.001) and the diaphragm (p = 0.001) were risk factors for BP and RR elevation.

Conclusions

Elevations in HR and BP are common. Risk factors for vital signs elevation include ablation zone abutting the parietal peritoneum and the diaphragm, as well as young age. These findings help devise strategies for anesthetic management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet. 2012;379(9822):1245–55. https://doi.org/10.1016/S0140-6736(11)61347-0.

    Article  PubMed  Google Scholar 

  2. Liang P, Wang Y, Yu X, Dong B. Malignant liver tumors: treatment with percutaneous microwave ablation—complications among cohort of 1136 patients. Radiology. 2009;251:933–40. https://doi.org/10.1148/radiol.2513081740.

    Article  PubMed  Google Scholar 

  3. Martin RC, Scoggins CR, McMasters KM. Safety and efficacy of microwave ablation of hepatic tumors: a prospective review of a 5-year experience. Ann Surg Oncol. 2010;17:171–8. https://doi.org/10.1245/s10434-009-0686-z.

    Article  PubMed  Google Scholar 

  4. Puijk RS, Ziedses des Plantes V, Nieuwenhuizen S, Ruarus AH, Vroomen LGPH, de Jong MC, et al. 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. Cardiovasc Intervent Radiol. 2019;42:1597–608. https://doi.org/10.1007/s00270-019-02273-y.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lai R, Peng Z, Chen D, Wang X, Xing W, Zeng W, et al. The effects of anesthetic technique on cancer recurrence in percutaneous radiofrequency ablation of small hepatocellular carcinoma. Anesth Analg. 2012;114:290–6. https://doi.org/10.1213/ANE.0b013e318239c2e3.

    Article  PubMed  Google Scholar 

  6. Crocetti L, de Baere T, Lencioni R. Quality improvement guidelines for radiofrequency ablation of liver tumours. Cardiovasc Interv Radiol. 2010;33:11–7. https://doi.org/10.1007/s00270-009-9736-y.

    Article  Google Scholar 

  7. Onik G, Onik C, Medary I, Berridge DM, Chicks DS, Proctor LT, et al. Life-threatening hypertensive crises in two patients undergoing hepatic radiofrequency ablation. AJR Am J Roentgenol. 2003;181:495–7. https://doi.org/10.2214/ajr.181.2.1810495.

    Article  PubMed  Google Scholar 

  8. Lee KJ, Ryu SH. A case of hypertensive crisis without a surge in adrenal hormones after radiofrequency ablation as a treatment for primary hepatocellular carcinoma. Korean J Gastroenterol. 2017;70:198–201. https://doi.org/10.4166/kjg.2017.70.4.198.

    Article  PubMed  Google Scholar 

  9. Park MJ, Kim Y, Rhim H, Lim HK, Shin BS, Choi D, et al. Prospective analysis of the pattern and risk for severe vital sign changes during percutaneous radiofrequency ablation of the liver under opioid analgesia. AJR Am J Roentgenol. 2010;194:799–808. https://doi.org/10.2214/AJR.09.3044.

    Article  PubMed  Google Scholar 

  10. Nakamura S, Nouso K, Onishi H, Kuwaki K, Hagihara H, Takeuchi Y, et al. Prevention of vagotonia and pain during radiofrequency ablation of liver tumors. Hepatol Res. 2014;44:1367–70. https://doi.org/10.1111/hepr.12321 (Epub 2014 Apr 2).

    Article  CAS  PubMed  Google Scholar 

  11. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone–alphadolone. Br Med J. 1974;2:656–9. https://doi.org/10.1136/bmj.2.5920.656.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Kang TW, Rhim H, Kim EY, Kim YS, Choi D, Lee WJ, et al. Percutaneous radiofrequency ablation for the hepatocellular carcinoma abutting the diaphragm: assessment of safety and therapeutic efficacy. Korean J Radiol. 2009;10(1):34–42. https://doi.org/10.3348/kjr.2009.10.1.34.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lee S, Rhim H, Kim Y, Choi D, Lee WJ, Lim HK, et al. Percutaneous radiofrequency ablation of hepatocellular carcinomas: factors related to intraprocedural and postprocedural pain. AJR Am J Roentgenol. 2009;192:1064–70. https://doi.org/10.2214/AJR.08.1350.

    Article  PubMed  Google Scholar 

  14. Blackburn SC, Stanton MP. Anatomy and physiology of the peritoneum. Semin Pediatr Surg. 2014;23:326–30. https://doi.org/10.1053/j.sempedsurg.2014.06.002.

    Article  PubMed  Google Scholar 

  15. Sato A, Schmidt RF. Somatosympathetic reflexes: afferent fibers, central pathways, discharge characteristics. Physiol Rev. 1973;53:916–47. https://doi.org/10.1152/physrev.1973.53.4.916.

    Article  CAS  PubMed  Google Scholar 

  16. Cervero F. Sensory innervation of the viscera: peripheral basis of visceral pain. Physiol Rev. 1994;74:95–138. https://doi.org/10.1152/physrev.1994.74.1.95.

    Article  CAS  PubMed  Google Scholar 

  17. Groudine SB, Hollinger I, Jones J, DeBouno BA. New York State guidelines on the topical use of phenylephrine in the operating room. The Phenylephrine Advisory Committee. Anesthesiology. 2000;92(3):859–64. https://doi.org/10.1097/00000542-200003000-00030.

    Article  CAS  PubMed  Google Scholar 

  18. Hsieh Y-C, Yap Y-S, Hung C-H, Chen C-H, Lu S-N, Wang J-H. Factors related to postoperative pain among patients who underwent radiofrequency ablation of hepatocellular carcinoma. Clin Radiol. 2013;68(6):600–7. https://doi.org/10.1016/j.crad.2012.12.006.

    Article  PubMed  Google Scholar 

  19. Kinsella SM, Tuckey JP. Perioperative bradycardia and asystole: relationship to vasovagal syncope and the Bezold-Jarisch reflex. Br J Anaesth. 2001;86:859–68. https://doi.org/10.1093/bja/86.6.859.

    Article  CAS  PubMed  Google Scholar 

  20. Hwang H-W, Hyun H-K, Kim Y-J, Kim J-W, Shin TJ. Evaluation of stress response during mesioden extraction under general anesthesia using heart rate variability. J Oral Maxillofac Surg. 2017;75:931–7. https://doi.org/10.1016/j.joms.2016.10.022.

    Article  PubMed  Google Scholar 

  21. Abhishekh HA, Nisarga P, Kisan R, Meghana A, Chandran S, Raju T, et al. Influence of age and gender on autonomic regulation of heart. J Clin Monit Comput. 2013;27:259–64. https://doi.org/10.1007/s10877-012-9424-3.

    Article  PubMed  Google Scholar 

  22. DiMarco AF. Diaphragm pacing. Clin Chest Med. 2018;39:459–71. https://doi.org/10.1016/j.ccm.2018.01.008.

    Article  PubMed  Google Scholar 

  23. Ward ME, Deschamps A, Roussos C, Hussain SN. Effect of phrenic afferent stimulation on pattern of respiratory muscle activation. J Appl Physiol. 1992;73:563–70. https://doi.org/10.1152/jappl.1992.73.2.563.

    Article  CAS  PubMed  Google Scholar 

  24. Abdunnur SV, Kim DH. Phrenic nerve stimulation: technology and clinical applications. Prog Neurol Surg. 2015;29:64–75. https://doi.org/10.1159/000434657.

    Article  PubMed  Google Scholar 

  25. Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology. 2003;226:441–51. https://doi.org/10.1148/radiol.2262012198.

    Article  PubMed  Google Scholar 

  26. Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology. 2003;226(2):441–51. https://doi.org/10.1148/radiol.2262012198.

    Article  PubMed  Google Scholar 

Download references

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), 300 Guangzhou Road, Gulou district, Nanjing, 210029, Jiangsu Province, China

    Wen-Tao Wu & Yu Chen

  2. Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Nanjing, China

    Wei-Zhong Zhou, Qing-Quan Zu, Zhen-Yu Jia, Bin Leng, Sheng Liu & Hai-Bin Shi

Authors
  1. Wen-Tao Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wei-Zhong Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qing-Quan Zu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhen-Yu Jia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bin Leng
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sheng Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hai-Bin Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yu Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

W-TW: Helped with conception of the work, data collection, analysis, and interpretation; and helped to draft the work and revise it critically and approve the final version of the manuscript. W-ZZ: Helped collect and analyze the data, and edit the manuscript. Q-QZ: Helped collect the data and edit the manuscript. Z-YJ: Helped collect the data and edit the manuscript. BL: Helped collect the data and edit the manuscript. SL: Helped review and approve the final manuscript. H-BS: Helped review and approve the final manuscript. YC: Helped design the study, review and analyze the data, write the article, and review and approve the final manuscript.

Corresponding author

Correspondence to Yu Chen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, WT., Zhou, WZ., Zu, QQ. et al. Risk factor for vital signs elevation during percutaneous microwave ablation of liver tumor under deep sedation. Jpn J Radiol 39, 1196–1205 (2021). https://doi.org/10.1007/s11604-021-01158-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11604-021-01158-w

Keywords

Search

Navigation